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Introducción: El cáncer colorrectal es una enfermedad que habitualmente aparece en ancianos y su principal tratamiento continúa siendo quirúrgico. La fragilidad es síndrome clínico que se caracteriza por presentar una disminución de la reserva fisiológica, aumenta con la edad y ha sido reconocido como un factor predictivo de mortalidad postoperatoria. Nuestro objetivo primario ha sido evaluar la asociación entre dos escalas de fragilidad y la mortalidad a un año después de la cirugía, y comparando la fuerza de su asociación del poder predictivo de mortalidad de las escalas de fragilidad y la de la clasificación de la American Society of Anesthesiologists (ASA). Las escalas utilizadas fueron: Modified Frailty Index (MFI) y el Risk Analysis Index (RAI-A). Los objetivos secundarios han sido la evaluación de la relación de las escalas de fragilidad con la morbilidad y la comparación de estas con la clasificación ASA en cuanto a predicción de morbilidad. Material y métodos: Analizamos retrospectivamente 172 pacientes mayores de 65 años que fueron intervenidos de cirugía oncológica colorrectal laparoscópica desde enero de 2017 hasta junio de 2018 con un seguimiento de un año posterior a la cirugía. Resultados: La fragilidad esta significativamente asociada a la mortalidad y morbilidad (p < 0,001). A más fragilidad, mayor probabilidad de estancia hospitalaria, complicaciones, reingresos y visitas a urgencias. Los pacientes fueron categorizados en dos grupos (pacientes frágiles y no frágiles). Los C-index de la predicción a mortalidad a un año obtenidos con el RAI-A y el MFI fueron 0,89 y 0,86, respectivamente. Por otro lado, la clasificación ASA no se relaciona con mortalidad, su C-index fue del 0,63. Discusión: Las escalas de fragilidad deberían empezar a influenciar las intervenciones médicas y quirúrgicas, y se deberían implementar guías y protocolos que tuviesen en cuenta el grado de fragilidad de los pacientes geriátricos.(AU)

Introduction: Colorectal cancer is a disease of the elderly and its main treatment is surgery. Frailty, a clinical syndrome of decreased reserve, increases with age and has been recognized as a predictive factor for postoperative mortality. Our primary objective was to assess the association between twohree frailty scores and mortality. within the first year after surgery, by retrospectively linking frailty scores to mortality data and comparing the strength of their association with mortality to that of the ASA Classification. The frailty scales used were: the Modified Frailty Index (MFI) and, the Risk Analysis Index-A (RAI-A) and the G8 screening test (G8). As secondary objectives, we assessed the relationship of the frailty scales with morbidity and compared all the scales with the ASA. Material and methods: We retrospectively studied 172 patients aged 65 years. and older who underwent laparoscopic colorectal surgery for cancer between January 2017 and June 2018, following them up for 1 year after surgery. Results: Both morbidity and mortality were significantly associated with all frailty scale scores (p < 0.001). The more frailty, the greater probability of prolonged hospital stay, complications, readmissions and emergency department visits. Using each scale, patients were categorized into two groups (frail and non-frail patients). The C-indexes for 1-year mortality with the RAI-A and, MFI and G8 were 0.89 and, 0.86 and 0.86 respectively. On the other hand, ASA status is not strongly associated with mortality, with a C-index of 0.63. Discussion: Frailty scores should begin to influence medical and surgical strategies and further research is needed to develop guidelines for interventions in geriatric patients.(AU)

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INTRODUCTION: Colorectal cancer is a disease of the elderly and its main treatment is surgery. Frailty, a clinical syndrome of decreased reserve, increases with age and has been recognized as a predictive factor for postoperative mortality. Our primary objective was to assess the association between two frailty scores and mortality within the first year after surgery, by retrospectively linking frailty scores to mortality data and comparing the strength of their association with mortality to that of the ASA Classification. The frailty scales used were: the Modified Frailty Index (MFI) and, the Risk Analysis Index-A (RAI-A) and the G8 screening test (G8). As secondary objectives, we assessed the relationship of the frailty scales with morbidity and compared all the scales with the ASA. MATERIAL AND METHODS: We retrospectively studied 172 patients aged 65 years and older who underwent laparoscopic colorectal surgery for cancer between January 2017 and June 2018, following them up for 1year after surgery. RESULTS: Both morbidity and mortality were significantly associated with all frailty scale scores (p<.001). The more frailty, the greater probability of prolonged hospital stay, complications, readmissions and emergency department visits. Using each scale, patients were categorized into two groups (frail and non-frail patients). The C-indexes for 1-year mortality with the RAI-A and, MFI and G8 were 0.89 and, 0.86 and 0.86 respectively. On the other hand, ASA status is not strongly associated with mortality, with a C-index of .63. DISCUSSION: Frailty scores should begin to influence medical and surgical strategies and further research is needed to develop guidelines for interventions in geriatric patients.

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The aim of this review was to assess the effectiveness of mirror therapy (MT) and action observation therapy (AOT) on upper limb-related body structures, body functions, activity, and involvement in patients with infantile cerebral palsy (ICP). We carried out a systematic review of randomized controlled trials published over the past 10 years, in which MT or AOT was compared to other ICP-directed interventions. Nine studies met the inclusion criteria and we measured their methodological quality using the PEDro scale. MT or AOT seem to significantly improve upper limb-related body structures, body function, activity, and participation in comparison to other interventions for ICP. Both seem to improve overall quality of life, reduce their disability, and promote its functioning. Further studies with higher methodological quality need to be developed to confirm the long-term effectiveness of MT and AOT.

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El objetivo de esta revisión fue evaluar la eficacia de la terapia en espejo (TE) y terapia de observación de acciones (AOT) en estructuras y funciones corporales, actividad y participación, relacionadas con miembro superior en parálisis cerebral infantil (PCI). Se realizó una revisión sistemática de ensayos controlados aleatorizados publicados en los últimos diez años, que investigaran TE o AOT frente a otras intervenciones en PCI. La calidad metodológica de los nueve estudios incluidos se evaluó con la escala PEDro. El tratamiento con TE o AOT parece mostrar mejoras significativas en estructuras y funciones corporales, actividades y participación del miembro superior comparado con otras intervenciones en PCI. Ambas intervenciones parecen mejorar la calidad de vida al abarcar la globalidad del paciente, reducir la discapacidad y favorecer su funcionamiento. Se necesitan más estudios con mayor calidad metodológica para respaldar estas intervenciones a largo plazo.(AU)

The aim of this review was to assess the effectiveness of mirror therapy (MT) and action observation therapy (AOT) on upper limbrelated body structures, body functions, activity, and involvement in patients with infantile cerebral palsy (ICP). We carried out a systematic review of randomized controlled trials published over the past 10 years, in which MT or AOT was compared to other ICP-directed interventions. Nine studies met the inclusion criteria and we measured their methodological quality using the PEDro scale. MT or AOT seem to significantly improve upper limbrelated body structures, body function, activity, and participation in comparison to other interventions for ICP. Both seem to improve overall quality of life, reduce their disability, and promote its functioning. Further studies with higher methodological quality need to be developed to confirm the longterm effectiveness of MT and AOT. (AU)

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La botriomicosis es una rara infección bacteriana granulomatosa crónica y supurativa de la piel y las vísceras. Se clasifica en 2 grupos: la forma cutánea, que puede producir afectación ósea y muscular por contigüidad, como parece probable en este caso, y la forma visceral.Se presenta un caso de botriomicosis muscular en el recto anterior del abdomen en un paciente con antecedente de intervención quirúrgica sobre la pared abdominal. Se interpretó como una tumoración neoplásica de partes blandas y el paciente fue sometido a resección quirúrgica con resultado de botriomicosis muscular. Se describen la presentación clínica y las características radiológicas (AU)

Botryomycosis is a rare chronic suppurative granulomatous bacterial infection of the skin and viscera. It is classified into 2 groups: the visceral type and the cutaneous type, which can lead to involvement of contiguous muscle and bone, as appears probable in this case.We present a rare case of muscular botryomycosis in the rectus abdominis muscle in a patient with a history of abdominal wall surgery. Botryomycosis was initially mistaken for a soft-tissue tumor; after surgical resection it was diagnosed as muscular botryomycosis. We describe the clinical presentation and the imaging characteristics of this rare entity (AU)

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Botryomycosis is a rare chronic suppurative granulomatous bacterial infection of the skin and viscera. It is classified into 2 groups: the visceral type and the cutaneous type, which can lead to involvement of contiguous muscle and bone, as appears probable in this case. We present a rare case of muscular botryomycosis in the rectus abdominis muscle in a patient with a history of abdominal wall surgery. Botryomycosis was initially mistaken for a soft-tissue tumor; after surgical resection it was diagnosed as muscular botryomycosis. We describe the clinical presentation and the imaging characteristics of this rare entity.

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Introducción. La tromboendarterectomía ilíaca ha sido desplazada primero por los bypass y, posteriormente,por las técnicas endovasculares. Objetivo. Revisar los resultados a corto y largo plazo de la tromboendarterectomía retrógraday abierta, y su indicación terapéutica actual. Pacientes y métodos. Incluimos todos los pacientes con patologíaoclusiva del sector ilíaco, independientemente de la afectación fémoropopliteodistal. Recogimos el sexo, la edad, los factoresde riesgo cardiovascular y la comorbilidad. Clasificamos a los pacientes en grupo I: tromboendarterectomía retrógrada,y grupo II: tromboendarterectomía abierta. De cada procedimiento analizamos la indicación quirúrgica, la clasificaciónde la lesión oclusiva ilíaca según la clasificación TASC II, la sutura arterial, la asociación con revascularizacióninfrainguinal y el número de reintervenciones. Analizamos la permeabilidad primaria, primaria-asistida, secundaria y elsalvamento de la extremidad de la serie completa y de cada grupo. Resultados. Intervinimos 101 pacientes con una edadmedia de 61 ± 10,6 años (38-86). El seguimiento medio fue de 87,2 ± 61,1 meses. Las permeabilidades de la serie completafueron: primaria: al mes, año, 5 y 10 años 93,6, 84, 72,2 y 68,2%; primaria-asistida: 99, 92,9, 88,4 y 71,8%; secundaria:99, 94,2, 90,2 y 84,4%. El salvamento de la extremidad fue del 96,3, 90,6, 85,6 y 81,9% y la supervivencia del 98,2,90,6, 73,5 y 47,9%. Al comparar ambos procedimientos observamos que el grupo I estaba constituido por pacientes deedad más avanzada (p = 0,048) y las lesiones tratadas según la clasificación TASC II eran menos complejas (p < 0,001).Conclusiones. La endarterectomía ilíaca presenta buenas permeabilidades tardías y de salvamento de la extremidad, quepueden constituir un buen recurso terapéutico en pacientes seleccionados(AU)

Introduction. Iliac thromboendarterectomies have been largely replaced, first, by bypasses and, later, by endovasculartechniques. Aim. To review short- and long-term outcomes of retrograde and open thromboendarterectomies,and the current therapeutic indication of these techniques. Patients and methods. We include all patients with anocclusive pathology of the iliac sector, regardless of femoral-popliteal-distal involvement. Data collected included sex,age, cardiovascular risk factors and comorbidity. Patients were classified into group I: retrograde thromboendarterectomy,and group II: open thromboendarterectomy. For each procedure, we analysed the surgical indication, the classificationof the iliac occlusive lesion according to the TASC II classification, the arterial suturing, the association withinfrainguinal revascularisation and the number of reinterventions. We also analysed the primary, assisted-primary andsecondary patency and limb salvage of the complete series and in each group. Results. Surgery was performed on 101patients, whose mean age was 61 ± 10.6 years (38-86). The mean follow-up time was 87.2 ± 61.1 months. The patenciesof the complete series were: primary: at one month, one year, 5 and 10 years 93.6, 84, 72.2, 68.2%; assisted-primary:99, 92.9, 88.4 and 71.8%; secondary: 99, 94.2, 90.2 and 84.4%. Limb salvage was 96.3, 90.6, 85.6 and 81.9%, andsurvival rate was 98.2, 90.6, 73.5 and 47.9%. On comparing the two procedures, it was observed that group I was madeup of patients of a more advanced age (p = 0.048) and the lesions treated, according to the TASC II classification, wereless complex (p < 0.001). Conclusions. Iliac endarterectomy offers good late patencies and limb salvage rates, and canconstitute a good therapeutic resource in selected patients(AU)

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OBJECTIVE: Rhabdomyomas are benign tumors of the skeletal muscle and extracardiac rhabdomyomas are very rare. METHODS/RESULTS: We report one case of spermatic cord rhabdomyoma in a 28-year-old male. CONCLUSIONS: Genital rhabdomyomas are rare benign tumors. Rhabdomyomas should be considered in the clinicopathological differential diagnosis of tumors of the male genital tract.

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Objetivo: Los rabdomiomas son tumores benignos del músculo esquelético cuya localización extracardiaca es rara. Métodos/Resultados: Presentamos un caso de rabdomioma de cordón espermático en un varón de 28 años de edad. Conclusiones: Los rabdomiomas genitales son tumores benignos poco frecuentes, y deben ser considerados en el diagnóstico diferencial de tumores del tracto genital masculino (AU)

Objective: Rhabdomyomas are benign tumors of the skeletal muscle and extracardiac rhabdomyomas are very rare. Methods/Results: We report one case of spermatic cord rhabdomyoma in a 28-year-old male. Conclusions: Genital rhabdomyomas are rare benign tumors. Rhabdomyomas should be considered in the clinicopathological differential diagnosis of tumors of the male genital tract (AU)

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OBJECTIVE: Lymphangiomas are lesions usually presenting during childhood and are located mainly in the head and neck region; less than 5% are intraabdominal. Lymphangiomatosis is the term used for multifocal or diffuse lymphangiomas. METHODS AND RESULTS: We report the case of a mesenteric lymphangiomatosis presenting as an acute abdomen in a 19-year-old man, review the literature and discuss the clinical management of these patients. CONCLUSIONS: Prognosis and treatment of these lesions depends of its site of origin and extension, being complete surgical excision the optimal treatment.

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OBJETIVO: El término linfangiomatosis se utiliza para definir los linfangiomas con afectación multifocal o difusa. Los linfangiomas son lesiones que se suelen presentar en la infancia y su localización más frecuente es cabeza y cuello, representando los linfangiomas intrabdominales menos de un 5%. MÉTODOS Y RESULTADOS: Presentamos un caso de linfangiomatosis mesentérica en un paciente de 19 años de edad que se presenta como cuadro de abdomen agudo, realizando revisión de la literatura y discusión del manejo de estos pacientes. CONCLUSIONES: El pronóstico y tratamiento de estas lesiones va a depender de su localización y extensión; siendo el tratamiento de elección la exéresis quirúrgica completa

OBJECTIVE: Lymphangiomas are lesions usually presenting during childhood and are located mainly in the head and neck region; less than 5% are intraabdominal. Lymphangiomatosis is the term used for multifocal or diffuse lymphangiomas. METHODS AND RESULTS: We report the case of a mesenteric lymphangiomatosis presenting as an acute abdomen in a 19-year-old man, review the literature and discuss the clinical management of these patients. CONCLUSIONS: Prognosis and treatment of these lesions depends of its site of origin and extension, being complete surgical excision the optimal treatment

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El síndrome de Swyer es una disgenesia gonadal pura, con cariotipo 46XY, fenotipo femenino normal, y ausencia completa de tejido gonadal funcionante, que está representado por unas cintillas gonadales rudimentarias, bilaterales, no funcionantes, compuestas por tejido fibroso, en presencia de genitales internos femeninos normales. La forma de presentación clínica más frecuente es amenorrea primaria. En un 20 por ciento existe mutación o deleción del gen SRY. En el 80 por ciento, el SRY es aparentemente normal. El riesgo de neoplasia gonadal es alto; está indicado practicar gonadectomía profiláctica preferentemente por laparoscopia. El gonadoblastoma y el disgerminoma son las neoplasias más comúnmente asociadas

Swyer syndrome is a pure gonadal dysgenesis with a 46XY karyotype, normal female phenotype, and complete lack of functioning gonadal tissue, which is represented by bilateral, nonfunctioning, rudimentary streak gonads composed of fibrous tissue, with normal female internal genitalia. They present most often with primary amenorrhea. To date, 20 percents of these are explained by a mutation or a deletion in SRY. In 80 percents, SRY is apparently normal. The risk of gonadal neoplasia is high, dictating early prophylactic removal of these dysgenetic gonads. Laparoscopic surgery is recommended. Gonadoblastoma and dysgerminoma are the most frequently reported malignancies

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OBJECTIVE: The aim of this study was to look for correlations between nuclear DNA content of colo-rectal tumors, and such clinical parameters as age, sex, location, CEA, histological grade and Duke's stages. EXPERIMENTAL DESIGN: A prospective study is carried out on surgical patients, subjected to standard criteria of radicality. Nuclear DNA content was quantified in tumoral cells by microcytophotometric techniques. PATIENTS: 106 patients with colo-rectal cancer. Patients with colonic perforation, other concomitant neoplasia, non-curative surgery or receiving adjuvant therapies were excluded from the study. Five patients died during the postoperative period and one was lost. RESULTS: Histological grade: 28% G1, 35% G2 and 37% G3. Dukes': 8% A, 40% B, 32% C and 20% D. DNA quantification has rendered 45% as euploid and 55% as aneuploid. There was no statistical correlation between ploidy and location, age, sex or CEA. However, there is a clear preponderance of euploid tumors in G1 (23 vs. 5), while the aneuploid tumors double the euploid ones (24 and 25 vs. 12 and 12) in G2 and G3. A similar result was found comparing ploidy and Dukes: euploid tumors reach 77% both in stages A and B, while they drop to 24% and 14% in stages C and D. It has also been found that euploid tumors show a longer period of survival free of recurrence. CONCLUSIONS: Evidence has been found supporting a prognostic value for tumoral DNA quantification in colo-rectal cancer. A longer follow-up is required to study absolute survival of the patients.

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El efecto analgésico de la administración peridural de lidocaina fue evaluado en un grupo de 22 pacientes, para analgesia de la labor de parto. Se utilizaron dosis de tanteo en 13 pacientes hasta establecer la dosis ideal que fue administrada en las restantes 9 pacientes. En dos pacientes se realizó cesárea por sufrimiento fetal agudo y deflexión de la presentación respectivamente. De las restantes 20 pacientes, 6 requirieron conducción del trabajo de parto y en 3 de estas se instauró durante el período expulsivo. Se comparó la valoración de APGAR en el RN con los de pacientes sin bloqueo sin encontrarse diferencia significativa, solo un caso presentó asfixia inicial leve.

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We have studied the influence of corporal weight and acute mesenteric ischemia (AMI) duration on the mortality and average survival of rats submitted to intestinal revascularization. The results demonstrated that mortality is under 50% when the AMI is equal or less than 2 hours. There are also important differences in mortality, for the same AMI duration, depending on the corporal weight and age of the animals. The differences are statistically significant up to 210 g. In conclusion, in experimental studies on intestinal ischemia-revascularization, it is necessary to correct for factors as ischemia duration and weight, which are variables that can alter the results.

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A case of acute urinary retention secondary to a giant bladder diverticulum in a 23-year-old patient is described. Its etiopathogenesis is briefly discussed, highlighting its congenital origin which, in our view, must be based on the histological examination of the specimen.

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We present a case of vesical Bilharziosis in a young black man. We briefly discuss the pathogeny, the diagnosis, based fundamentally on the microscopic study of urine and cystoscopy, as well as the treatment with Praziquantel as the preferential medication in Schistosomiasis due to S. haematobium.

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