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INTRODUCTION: Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events. CONCLUSION: We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA. LEVEL OF EVIDENCE: I.

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BACKGROUND: Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty. METHODS: A randomized, single-center, parallel, open clinical trial was performed in adult patients undergoing primary total knee arthroplasty. Patients were divided into four groups. Group 1 received fibrin glue manufactured by the Blood and Tissue Bank of Catalonia, Group 2 received Tissucol (fibrinogen and thrombin), Group 3 received intravenous tranexamic acid, and Group 4 (control) had no treatment other than routine hemostasis. The primary outcome was total blood loss collected in drains after surgery. Secondary outcomes were the calculated hidden blood loss, transfusion rate, preoperative and postoperative hemoglobin, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and seventy-two patients were included. The mean total blood loss (and standard deviation) collected in drains was 553.9 ± 321.5 mL for Group 1, 567.8 ± 299.3 mL for Group 2, 244.1 ± 223.4 mL for Group 3, and 563.5 ± 269.7 mL for Group 4. In comparison with the control group, Group 3 had significantly lower total blood loss (p < 0.001), but it was not significantly lower in Groups 1 and 2. The overall rate of patients who had a blood transfusion was 21.1% (thirty-five of 166 patients analyzed per protocol). Two patients required transfusion in Group 3 compared with twelve patients in Group 4 (p = 0.015). No significant difference was observed between the two fibrin glue groups and the control group with regard to the need for transfusion. There was no difference between groups with regard to the percentage of adverse events. CONCLUSIONS: Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.

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Objetivo: Analizar la relación entre la presencia de lesiones sincrónicas en el cáncer colo-rectal y su pronóstico. Método: Revisamos 369 cánceres colo-rectales resecados. Comparamos el porcentaje de cirugía aparentemente curativa, la progresión y recidiva tumoral, aparición posterior de cáncer extra-colónico y mortalidad entre los cánceres sincrónicos y el resto. Analizamos los cánceres con adenomas sincrónicos frente al resto de casos. Repetimos el estudio estratificando los casos según su estadio pTNM: estadios 0-I-II versus III-IV. Resultados: Registramos un 7,6% de cánceres sincrónicos y un 54,7% de adenomas sincrónicos. El seguimiento entre los grupos con y sin cáncer sincrónico fue de 70,8 ± 22,9 vs 67,2 ± 24,5 meses (p = 0,55). Los cánceres sincrónicos mostraron mayor mortalidad: 35,7% vs. 14,4%:p = 0,006; OR = 3,31 (1,33-8,13), mayor progresión tumoral: 39,3 vs.19,1%: p = 0,011; OR = 2,75 (1,14-6,56) y mayor recidiva: 10,7 vs.3,5%: p = 0,096. Al estratificar según el estadio, los pacientes con estadio 0-I-II y cáncer sincrónico mantuvieron peor pronóstico: mortalidad =27,7 vs. 8,1% p = 0,019; OR = 4,45 (1,20-15,10), progresión tumoral =27,8 vs. 8,5% p = 0,02; OR = 4,12 (1,14-14,19), cáncer extra-colónico =16,7 vs. 6,4% p = 0,095. No encontramos diferencias entre los casos con y sin adenomas sincrónicos. Conclusiones: Los cánceres sincrónicos muestran peor pronóstico tras la resección, con mayor tasa de progresión tumoral y mortalidad. Esta diferencia se centra en los casos diagnosticados en estadios 0-I-II, perdiéndose en los estadios III-IV. En nuestra serie, la presencia de adenomas sincrónicos no influye en el pronóstico

Aim: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. Patients and methods: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters incolorectal cancer with and without synchronous adenomas. Finally, were peated the analysis after stratification of cancers in 2 groups accordingto pTNM staging: 0-I-II stage vs III-IV. Results: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 ± 22.9 and 67.2 ± 24.5 months (p= 0.55) respectivelly. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression: 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis:mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Conclusions: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found inIII-IV. The presence of synchronous adenomas doesn’t influence prognosis

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AIM: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. PATIENTS AND METHODS: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. RESULTS: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 +/- 22.9 and 67.2 +/- 24.5 months (p = 0.55) respectively. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. CONCLUSIONS: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.

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We present the case of a 63-year-old woman with heterotaxy syndrome and polysplenia who presented with clinical signs and symptoms of recurrent acute pancreatitis in which the biliary origin had been seen in the most recent episode. This syndrome is rare in adult patients because it is associated with congenital heart defects. It is important to know the visceral anomalies that are common in this syndrome to avoid confusing them with pathological processes.

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Presentamos el caso de una mujer de 63 años de edad, con syndrome de heterotaxia con poliesplenia, que presentaba clínica de pancreatitis aguda recidivante, visualizándose en el último episodio su origen biliar.Este síndrome es raro en la edad adulta, debido a que se asocial con malformaciones cardíacas congénitas. Es importante conocer las anomalías viscerales de este síndrome, para evitar confundirlas con procesos patológicos

We present the case of a 63-year-old woman with heterotaxy syndrome and polysplenia who presented with clinical signs and symptoms of recurrent acute pancreatitis in which the biliary origin had been seen in the most recent episode. This syndrome is rare in adult patients because it is associated with congenital heart defects. It is important to know the visceral anomalies that are common in this síndrome to avoid confusing them with pathological processes

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El hamartoma de glándulas de Brunner es un raro tumor duodenal localizado con mayor frecuencia a nivel de la primera porción, que si bien puede ser asintomático no es raro que produzca cuadros de hemorragia digestiva u obstrucción intestinal. Su diagnóstico se realiza por gastroscopia o estudio digestivo baritado y su tratamiento consiste en la resección endoscópica o quirúrgica, con muy buen pronóstico. Presentamos el caso de una mujer de 59 años que acude al hospital con un cuadro clínico de hemorragia digestiva alta presentando en la endoscopia realizada una úlcera sobre un pólipo en bulbo duodenal. Se realizó polipectomía correspondiendo en el estudio histológico a un hamartoma de glándulas de Brunner en cuyo interior aparecía un granuloma parasitario. La determinación de IgE para Anisakis así como los test cutáneos fueron positivos. La asociación de hamartoma de glándulas de Brunner y granuloma parasitario por Anisakis no se había descrito nunca (AU)

Brunner´s gland hamartoma is a rare duodenal tumor generally localized in the duodenal bulb. Normally assymptomatic, it might cause upper gastrointestinal bleeding or intestinal obstruction. The diagnosis is based on upper gastrointestinal endoscopic or barium examination findings, and its treatment includes surgical or endoscopic ressection, with an optimum prognosis. We present the case of a 59-year-old woman who was admitted to the hospital with an upper gastrointestinal bleeding picture. Endoscopic examination showed an ulcerated polyp in duodenal bulb which was cut with polipectomy wire. Histological slides showed a parasitic granuloma within a Brunner´s gland hamartoma. Skin prick test and specific IgE determination were positive for Anisakis. Up to our knowledge, this association has never been described before (AU)

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Brunner's gland hamartoma is a rare duodenal tumor generally localized in the duodenal bulb. Normally assymptomatic, it might cause upper gastrointestinal bleeding or intestinal obstruction. The diagnosis is based on upper gastrointestinal endoscopic or barium examination findings, and its treatment includes surgical or endoscopic resection, with an optimum prognosis. We present the case of a 59-year-old woman who was admitted to the hospital with an upper gastrointestinal bleeding picture. Endoscopic examination showed an ulcerated polyp in duodenal bulb which was cut with polipectomy wire. Histological slides showed a parasitic granuloma within a Brunner's gland hamartoma. Skin prick test and specific IgE determination were positive for Anisakis. Up to our knowledge, this association has never been described before.

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OBJECTIVES: to analyze retrospectively our hospital records on patients diagnosed during the period from 1983 to 1993 as having Crohn's disease or ulcerative colitis, and to estimate the incidence and epidemiological characteristics of these diseases in the Pamplona health administration area. METHODS: 246 patients were diagnosed has having inflammatory bowel disease (147 with ulcerative colitis, 97 with Crohn's disease, and 2 with indeterminate colitis. RESULTS: mean incidence was 2.47 +/- 0.96 per 100 000 inhabitants for Crohn's disease, and 3.75 +/- 1.5 per 100 000 inhabitants for ulcerative colitis (p < 0.05). There was a nonsignificant increase in incidence during the study period. Age, sex, alcohol intake, smoking habit and familial aggregation were analyzed. CONCLUSIONS: mean estimated incidence of Crohn's disease and ulcerative colitis in our setting during 1983-1993 was similar to that reported more recently for other parts of Spain. In our setting, ulcerative colitis was significantly more frequent that Crohn's disease, and familial aggregation was lower among patients who had the former disease. Crohn's disease was diagnosed at earlier ages, and cigarette smoking was more frequent among patients with this disease.

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An accurate diagnosis of acetabular fractures requires both an anteroposterior radiograph, and two oblique views which are usually obtained by rolling the patient 45 degrees first toward one side and then toward the other. To avoid the discomfort this can cause the patient, we have devised a method that uses standard x-ray equipment but keeps the patient resting supine on the table. The desired oblique views are obtained by tilting the x-ray tube 30 degrees from a medial-to-lateral direction and from a lateral-to-medial direction.

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