RESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fallo Hepático Agudo/complicaciones , Fallo Hepático/complicaciones , Fallo Hepático/cirugía , Fístula Biliar/cirugía , Fístula Biliar , Colangiocarcinoma/complicaciones , Colangiocarcinoma/cirugía , Colangiocarcinoma , Ascitis/complicaciones , AscitisRESUMEN
The main cause of morbimor-mortality after major liver surgery is the development of liver failure posthepatectomy(LFPH). Treatment must involve multiple options and will be aggressive from the beginning. We report a case of a patient with cholangiocarcinoma perihilar treated with surgery: right hepatectomy extended to sI + IVb with develop of LFPH and biliary fistula and being management successfully in a multidisciplinary way.
Asunto(s)
Fístula Biliar/cirugía , Hepatectomía/efectos adversos , Fallo Hepático/etiología , Fallo Hepático/terapia , Complicaciones Posoperatorias/terapia , Neoplasias de los Conductos Biliares/cirugía , Colangiocarcinoma/cirugía , Humanos , Neoplasias Hepáticas/cirugía , Regeneración Hepática , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Introducción: Con el objetivo de demostrar la eficacia de los adhesivos biológicos a base de fibrina en la prevención de fugas anastomóticas, en enero de 2007 iniciamos un estudio multicéntrico, prospectivo, aleatorizado, controlado, simple ciego, sobre la prevención de fugas anastomóticas en anastomosis del tubo digestivo de alto riesgo mediante la utilización de adhesivos biológicos a base de fibrina. Material y métodos En enero de 2007 iniciamos un ensayo clínico multicéntrico en el que participan los hospitales Gregorio Marañón, Universitario de San Carlos y Hospital del Sureste, de Madrid sobre la prevención de defectos de cicatrización anastomótica mediante la aplicación de adhesivos biológicos a base de fibrina en la linea de sutura. Los pacientes reclutados se aleatorizan asignando al paciente en función de esta aleatorización a uno de los 2 grupos: grupo de estudio en el que se aplica adhesivo en la línea de sutura y grupo control en el que no se aplica. La variable principal del estudio es la presencia o ausencia de fugas. El ensayo ha sido aprobado por los correspondientes Comités de Ética e Investigación Clínica, por la Agencia Española del Medicamento y registrado en www.clinicaltrials.gov (NCT01306851). Ninguno de los autores manifiesta tener conflicto de interés con la empresa Baxter, que comercializa el producto en España. Resultados Desde enero de 2007 hasta noviembre de 2010, se ha reclutado a 104 pacientes que han sido asignados tras aleatorización, 52 al grupo de estudio y 52 al grupo control. Se han registrado 22 fugas anastomóticas de las cuales 7 en el grupo de estudio (13, 4%) y 15 en el grupo control (28, 8%) con un valor de la P de 0,046. El índice de riesgo de fugas fue de 0,384, es decir, se produce una reducción del 61% en las fugas de los pacientes a los que se aplica adhesivo biológico a (..) (AU)
Introduction: A multicentre, prospective, randomised, controlled, and simple blind clinicaltrial was started in January 2007, with the aim of demonstrating the eficacy of fibrin-based biological adhesives in the prevention of anastomotic leaks in the high risk digestive tract. Material and methods: A study on the prevention of anastomotic healing defects by applying biological adhesives along the suture line began in January 2007, and included the hospitals, Gregorio Marañón, Universitario de San Carlos, and Hospital del Sureste, in Madrid. The enrolled patients were randomised to one of 2 groups: the study group in which the adhesive was applied to the suture line, and a control group in which it was not applied. The primary outcome of the study was the presence or absence of leaks. The trial was approved by the corresponding Clinical Research Ethics Committees and the Spanish Medicines Agency(AEMPS) and registered www.clinicaltrials.gov (NCT01306851). The authors declared not to have any (..) (AU)
Asunto(s)
Humanos , Adhesivo de Tejido de Fibrina/uso terapéutico , Anastomosis Quirúrgica/métodos , Técnicas de Sutura , Ensayos Clínicos Fase IV como Asunto/métodos , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Reoperación/estadística & datos numéricosRESUMEN
INTRODUCTION: A multicentre, prospective, randomised, controlled, and simple blind clinical trial was started in January 2007, with the aim of demonstrating the efficacy of fibrin-based biological adhesives in the prevention of anastomotic leaks in the high risk digestive tract. MATERIAL AND METHODS: A study on the prevention of anastomotic healing defects by applying biological adhesives along the suture line began in January 2007, and included the hospitals, Gregorio Marañón, Universitario de San Carlos, and Hospital del Sureste, in Madrid. The enrolled patients were randomised to one of 2 groups: the study group in which the adhesive was applied to the suture line, and a control group in which it was not applied. The primary outcome of the study was the presence or absence of leaks. The trial was approved by the corresponding Clinical Research Ethics Committees and the Spanish Medicines Agency (AEMPS) and registered www.clinicaltrials.gov (NCT01306851). The authors declared not to have any conflict of interests with the company, Baxter, which markets the product in Spain. RESULTS: A total of 104 patients were recruited between January 2007 and November 2010, of whom 52 were randomised to the study group, and 52 to the control group. A total of 22 anastomotic leaks were recorded, of which 7 (13.4%) were in the study group, and 15 (28.8%) in the control group (P=.046). The leak risk index was 0.384, which means that there was a 61% reduction in leaks in the patients who had the fibrin-based biological adhesive applied. There were 3 (5.7%) further surgeries in the study group, compared to 12 (23%) in the control group (P=.12). On analysing the mortality, it was observed that 3 patients in the study group and 4 patients in the control group died (5.7% vs. 7.7%, P=.5). No other significant differences were found as regards the type of suture, surgical time, or pre-surgical history, except that the use of drainages appeared to be a protective factor of anastomotic leak (P=.041), although the use or not of a drainage was not a controlled factor, but at the discretion of each surgeon. CONCLUSIONS: Our study demonstrates, significantly, that in the 104 patients in the study that fibrin based biological adhesives are capable of preventing anastomotic leaks in the high risk digestive tract, reducing the risk of leaks by 61% and a further surgeries. This is the first clinical trial that shows these significant results. If our results are maintained at the end of the study, it will show that anastomotic leaks can be prevented with the application of these adhesives, thus their application may be recommended in all the anastomosis of the high risk digestive tract.
Asunto(s)
Fuga Anastomótica/prevención & control , Adhesivo de Tejido de Fibrina , Adhesivos Tisulares , Adulto , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles , Femenino , Tracto Gastrointestinal , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , SuturasAsunto(s)
Neoplasias de los Nervios Craneales , Neurilemoma , Enfermedades del Nervio Vago , Neoplasias de los Nervios Craneales/diagnóstico , Neoplasias de los Nervios Craneales/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurilemoma/cirugía , Enfermedades del Nervio Vago/diagnóstico , Enfermedades del Nervio Vago/cirugíaRESUMEN
Acute appendicitis is the most common abdominal surgical emergency. Atypical presentations lead to a late diagnosis with a higher complication rate. Given its rarity, we report a case of a thoracic empyema due to subphrenic appendicitis.
Asunto(s)
Apendicitis/complicaciones , Empiema Pleural/etiología , Absceso Subfrénico/etiología , Enfermedad Aguda , Anciano , Apendicitis/diagnóstico , Apendicitis/cirugía , Drenaje , Empiema Pleural/diagnóstico , Humanos , Masculino , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/cirugíaRESUMEN
Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.
Asunto(s)
Absceso Abdominal/etiología , Cálculos Biliares/complicaciones , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/cirugía , Anciano , Colecistectomía , Drenaje , Cálculos Biliares/cirugía , Humanos , Masculino , Radiografía AbdominalRESUMEN
Los cálculos abandonados tras apertura accidental durante una colecistectomía, generalmente laparoscópica, pueden producir complicaciones tardías, siendo el absceso intraabdominal la más frecuente. El diagnóstico se basa en la prueba de imagen (ecografía/tomografía computerizada), siendo el drenaje y la extracción quirúrgica de los cálculos la mejor opción terapéutica, ya que el drenaje percutáneo presenta una elevada tasa de fracasos. Sin embargo, el absceso en pared abdominal posterior como manifestación inicial de un absceso intraabdominal debido a colelitiasis retenida es poco frecuente, por lo que reportamos este caso.
Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.
Asunto(s)
Humanos , Masculino , Anciano , Absceso Abdominal , Colecistectomía Laparoscópica , Colecistectomía Laparoscópica/efectos adversos , CálculosRESUMEN
Introducción La colitis isquémica (CI) es la forma más frecuente de enfermedad isquémica digestiva y está infradiagnosticada. Objetivos Describir los resultados obtenidos en pacientes con CI que necesitaron de intervención quirúrgica en nuestro centro, y evaluar los factores predictores de mortalidad. Métodos Los datos fueron obtenidos de la base de CI del Hospital Gregorio Marañón. Las características demográficas, clínicas, los métodos diagnósticos, las técnicas quirúrgicas empleadas y la mortalidad fueron analizados estadísticamente empleando la prueba de la χ2 y la t de Student. Resultados Entre 1991 y 2006, se operó a 101 pacientes con CI. La mayoría de éstos tenían antecedentes cardiovasculares y 35 casos fueron diagnosticados durante su ingreso hospitalario por otra causa. Tanto los signos como los síntomas fueron inespecíficos en el 40% de los casos. La morbilidad y la mortalidad total fue del 39,6 y el 41,6%, respectivamente. En los casos de CI postoperatoria, la mortalidad se elevó hasta el 68% (p<0,01); el 93% de los paciente que fallecieron tenían necrosis transmural durante la cirugía (p<0,05) y el 69% tenía acidosis metabólica. Conclusiones La mortalidad en pacientes afectos de CI que necesitan intervención quirúrgica es alta, especialmente si el diagnóstico se hace en el postoperatorio de otra cirugía o si se evidencia necrosis transmural durante la intervención. Para mejorar estos resultados el diagnóstico precoz es la mejor arma, y debe basarse en un alto índice de sospecha(AU)
IntroductionIschaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed. Objectives To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality. Methods The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the χ2 and Student t test. Results One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis. Conclusions The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results (AU)
Asunto(s)
Humanos , Colitis Isquémica/mortalidad , Ajuste de Riesgo/métodos , Colitis Isquémica/cirugía , Factores de Riesgo , Estudios RetrospectivosRESUMEN
INTRODUCTION: Ischaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed. OBJECTIVES: To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality. METHODS: The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the chi(2) and Student t test. RESULTS: One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis. CONCLUSIONS: The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results.
Asunto(s)
Colitis Isquémica/mortalidad , Colitis Isquémica/cirugía , Anciano , Colitis Isquémica/diagnóstico , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management. OBJECTIVE: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients. METHODS: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month. RESULTS: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery. CONCLUSIONS: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs.
Asunto(s)
Atención Ambulatoria , Diverticulitis/tratamiento farmacológico , Dolor Abdominal/etiología , Absceso/etiología , Enfermedad Aguda , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/economía , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Pólipos del Colon/complicaciones , Pólipos del Colon/diagnóstico , Terapia Combinada , Diverticulitis/complicaciones , Diverticulitis/diagnóstico , Diverticulitis/dietoterapia , Diverticulitis/economía , Femenino , Humanos , Hallazgos Incidentales , Leucocitosis/etiología , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Introducción: el tratamiento de la diverticulitis aguda está siendo recientemente revisado y muestra una tendencia a limitar el tratamiento quirúrgico y potenciar el de tipo conservador.Objetivo: analizar la eficiencia y la seguridad del tratamiento ambulatorio de la diverticulitis aguda en un grupo seleccionado de pacientes.Métodos: estudio prospectivo sobre el tratamiento antibiótico oral domiciliario de la diverticulitis aguda en una cohorte de pacientes, realizado en la sección de cirugía de urgencias de nuestro centro.Pacientes y tratamiento: 74 pacientes (44 varones y 30 mujeres) fueron incluidos en el período 20002006; se seleccionaron los tipo I de Hinchey y los tipo II con absceso menor de 3cm, clínica y analíticamente estables, y se trataron con ciprofloxacino y metronidazol, por vía oral, durante 710 días. El seguimiento se realizó en consultas externas mediante control clínico a los 10 días y prueba de imagen al cabo de un mes.Resultados: la edad media era de 55 años. La presentación clínica más frecuente fue dolor abdominal espontáneo asociado a leucocitosis. La duración media del tratamiento fue de 8,8 días. Cuatro pacientes (5,4%) precisaron ingreso posterior para tratamiento antibiótico intravenoso y 70 (94,6%) completaron el tratamiento sin complicaciones. Durante el seguimiento diagnosticamos 2 casos de adenocarcinoma de colon y 6 de poliposis. Solamente 13 pacientes recibieron cirugía electiva.Conclusiones: el manejo conservador ambulatorio ha demostrado ser seguro y eficaz en el tratamiento de la diverticulitis aguda no complicada en la mayoría de los pacientes de nuestro estudio, consiguiendo además una reducción de la estancia hospitalaria y una minimización de los costes(AU)
Introduction: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management.Objective: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients.Methods: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 710 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month.Results: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery.Conclusions: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs(AU)