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INTRODUCTION: Wilms' tumor (WT) is the most frequent renal tumor in childhood. Therapeutic management progression has increased survival rates, and as a result, long-term adverse effects. MATERIALS AND METHODS: A descriptive retrospective study of a case series from 1977 to 2023 was carried out. The characteristics of the treatments received and the adverse effects listed on medical records were analyzed via phone surveys. RESULTS: 50 patients (25 boys-25 girls) with a mean age of 3.6 years (3 months-11 years) at diagnosis were included. Most of them (94%) were treated according to the protocol established by the European standards of pediatric oncology, which are characterized by the use of neoadjuvant chemotherapy. In one patient, the American treatment scheme was followed. The most common drugs used were vincristine and actinomycin D (78%). Only 12 patients (28%) received anthracyclines. Unilateral nephrectomy was the most frequent surgical technique (84%). Renal disorders were the most common (46%). However, the occurrence of second neoplasias (9%) and reproductive disorders (8% between boys and girls) had a greater impact on patients' quality of life. Multiple - cardiac (23%), endocrine (26%), and pulmonary (15%) - disorders associated with the treatments received were reported. CONCLUSIONS: WT treatment has an impact on health. Adequate and rigorous surgery, close follow-up, and limiting chemotherapy doses and radiation exposure can minimize long-term sequels.

INTRODUCCION: El tumor de Wilms (TW) es el tumor renal más frecuente en la infancia. La evolución del manejo terapéutico ha incrementado la tasa de supervivencia y como consecuencia, los efectos secundarios a largo plazo. MATERIAL Y METODOS: Realizamos un estudio retrospectivo descriptivo a partir de una serie de casos entre 1977 y 2023. Estudiamos las características de los tratamientos recibidos y los efectos secundarios que constan en su historia clínica y a través de cuestionarios telefónicos. RESULTADOS: Localizamos 50 pacientes (25 hombres-25 mujeres) con edad media al diagnóstico de 3,6 años (3 meses-11 años). La mayoría fueron tratados según protocolo vigente de las guías europeas de oncología pediátrica (94%) caracterizadas por el uso de quimioterapia neoadyuvante. En un paciente Se siguió el esquema americano de tratamiento. Los fármacos más utilizados fueron vincristina y actinomicina D (78%); solo 12 pacientes (28%) recibieron antraciclinas. La nefrectomía unilateral fue la técnica quirúrgica más empleada (84%). Las alteraciones renales fueron las más frecuentes (46%). Sin embargo, la aparición de segundas neoplasias (9%) y aquellas alteraciones relacionadas con la reproducción (8% entre hombres y mujeres) suponen un mayor impacto en la calidad de vida de los pacientes. Se describen múltiples alteraciones: cardíacas (23%), endocrinas (26%) o pulmonares (15%) relacionadas con los tratamientos recibidos. CONCLUSIONES: El tratamiento del TW afecta a la salud general. Una cirugía adecuada y rigurosa, limitar las dosis de quimioterapia, minimizar la exposición a la radiación y un seguimiento estrecho puede minimizar las secuelas a largo plazo.

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Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

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Venous thromboembolic disease (VTE) is a frequent complication in patients diagnosed with cancer and a cause of morbidity and mortality. Approximately 20% of thromboembolic episodes develop in association with active cancer. On the other hand, it is estimated that about 2-12% of cases, the thromboembolic episode is the first manifestation of an occult cancer, diagnosed at that time or subsequently, which offers an opportunity for early diagnosis and treatment. There are multiple factors that contribute to increase the risk of VTE in oncological patients in relation to specific characteristics of the patient, the tumor and the treatments. Knowledge of these risk factors will contribute to early diagnosis when signs of VTE appear, as well as the assessment of thromboprophylaxis if indicated. The diagnosis of VTE in patients with cancer does not differ of those who do not suffer from it. Regarding the treatment of VTE in these patients, low molecular weight heparin (LMWH), direct acting anticoagulants (DACs) and antivitamin K (VKA) are the most commonly used, although the dosing regimen and length are not clear yet. The management of these patients should be interdisciplinary and early, so the primary care physician plays a key role in this process as he/she is liaise with his/her patients. It is also necessary to update knowledge in order to improve the care of these patients. For these reasons, this document has been prepared by the Working Group on Vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) whose objective is to present the available information regarding the management of VTE that may appear in oncological patients, as well as the assessment of thromboprophylaxis and treatment, if appropriate, from an approach focused on a primary care field.

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La enfermedad venosa crónica (EVC) es la enfermedad vascular más frecuente en el ser humano y sigue siendo infradiagnosticada e infratratada en todos los niveles asistenciales. Los nuevos tiempos que vivimos suponen un aumento de la incertidumbre entre los pacientes crónicos sobre su diagnóstico, tratamiento y seguimiento por parte de los médicos de familia y especialmente en la EVC. Con el fin de abordar estos nuevos tiempos, el Grupo de Vasculopatías de Semergen ha diseñado el cuestionario Venocheck, que valora aspectos etiológicos, clínicos (clasificación CEAP), de severidad y calidad de vida, terapéuticos, presencia de complicaciones y criterios de derivación (AU)

Chronic venous disease (CVD) is the most common vascular disease in humans and continues to be underdiagnosed and undertreated at all levels of care. The new times we live in have led to an increase in uncertainty among chronic patients about their diagnosis, treatment and follow-up by family doctors and especially in CVD. In order to analyze these new times, the Semergen Vasculopathies Group has created the Venocheck questionnaire, which assesses aetiological, clinical (CEAP classification), severity and quality of life, therapeutic aspects, presence of complications and referral criteria (AU)

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Chronic venous disease (CVD) is the most common vascular disease in humans and continues to be underdiagnosed and undertreated at all levels of care. The new times we live in have led to an increase in uncertainty among chronic patients about their diagnosis, treatment and follow-up by family doctors and especially in CVD. In order to analyze these new times, the Semergen Vasculopathies Group has created the Venocheck questionnaire, which assesses aetiological, clinical (CEAP classification), severity and quality of life, therapeutic aspects, presence of complications and referral criteria.

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Introducción: La prevalencia de la enfermedad renal crónica (ERC) ha aumentado a nivel global (8-16%), debido principalmente a la incidencia de diabetes mellitus tipo 2 (DM2) y de hipertensión arterial (HTA). La educación o formación de los pacientes con enfermedades crónicas se considera una herramienta fundamental para prevenir el empeoramiento de estas. Objetivos: 1) Determinar si la asistencia a la formación de pacientes con hipertensión y/o diabetes, influye en la progresión o el desarrollo del deterioro de la función renal. 2) Valorar la asociación de la función renal con HTA, DM2 y la aparición de eventos cardiovasculares, analizando la influencia del grado de control de la presión arterial (PA) y la hemoglobina glicada (HbA1c). 3) Estudiar la aparición de eventos cardiovasculares. Material y métodos: Estudio observacional analítico de cohortes retrospectivo llevado a cabo en un Centro de Salud de Leganés, Madrid, utilizando bases de datos de pacientes con hipertensión, diabetes y ambas patologías a la vez (n = 200), asistentes o no a la formación del equipo médico durante los años 2017 a 2019. Resultados: Recibieron formación 120 de 200 pacientes (67,5% mujeres). Sólo en estos se observó una mejoría de la función renal acompañada de una reducción de las cifras de presión arterial (PA) y HbA1c, donde se apreció un mejor control y seguimiento de la enfermedad, siendo más destacada en pacientes con una sola patología, especialmente aquellos con hipertensión. Conclusiones: La formación de los pacientes resultó beneficiosa para prevenir el deterioro de la función renal, mediante la reducción de las cifras de PA y HbA1c, y fue más evidente en aquellos que partieron de un peor control de ambas. Se demostró la asociación de la evolución de la función renal con HTA y DM2 (AU)

Introduction: The prevalence of chronic kidney disease has increased globally (8–16%), mainly due to the incidence of type 2 diabetes mellitus (DM2) and hypertension (HT). Education or training programs for patients with chronic diseases is considered a fundamental tool to prevent their worsening. Objectives: (1) To determine whether attendance at training for patients with HT and/or diabetes affects the progression of the deterioration of renal function. (2) To assess the association of renal function with HT, DM2 and the occurrence of cardiovascular events, analyzing the influence of the control degree of blood pressure (BP) and glycated hemoglobin (HbA1c). (3) To study the occurrence of cardiovascular events. Material and methods: Retrospective analytical observational cohort study carried out in a Primary Care Center in Leganés, Madrid, using databases of patients with HT, diabetes and both pathologies simultaneously (n = 200), attending or not to the training of the medical team during the years 2017–2019. Results: 120 of 200 patients received training (60% women). Only in these patients, an improvement of renal function was observed. This was accompanied by a reduction in BP and HbA1c levels, being more prominent in patients with a single pathology, especially hypertensive patients. Conclusions: Training of patients was beneficial to prevent the deterioration of renal function, by means of the reduction of the BP and HbA1c. It was more evident in those who started from a worse control of both parameters. Association of renal function evolution with HT and DM2 was demonstrated (AU)

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INTRODUCTION: The prevalence of chronic kidney disease has increased globally (8-16%), mainly due to the incidence of type 2 diabetes mellitus (DM2) and hypertension (HT). Education or training programs for patients with chronic diseases is considered a fundamental tool to prevent their worsening. OBJECTIVES: (1) To determine whether attendance at training for patients with HT and/or diabetes affects the progression of the deterioration of renal function. (2) To assess the association of renal function with HT, DM2 and the occurrence of cardiovascular events, analyzing the influence of the control degree of blood pressure (BP) and glycated hemoglobin (HbA1c). (3) To study the occurrence of cardiovascular events. MATERIAL AND METHODS: Retrospective analytical observational cohort study carried out in a Primary Care Center in Leganés, Madrid, using databases of patients with HT, diabetes and both pathologies simultaneously (n = 200), attending or not to the training of the medical team during the years 2017-2019. RESULTS: 120 of 200 patients received training (60% women). Only in these patients, an improvement of renal function was observed. This was accompanied by a reduction in BP and HbA1c levels, being more prominent in patients with a single pathology, especially hypertensive patients. CONCLUSIONS: Training of patients was beneficial to prevent the deterioration of renal function, by means of the reduction of the BP and HbA1c. It was more evident in those who started from a worse control of both parameters. Association of renal function evolution with HT and DM2 was demonstrated.

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Giant cell arteritis is a systemic vasculitis with significant intra and extracranial involvement that, with early diagnosis and treatment in primary care, can improve its prognosis as it is a medical emergency. Our working group on vascular diseases of the Spanish Society of Primary Care Physicians (SEMERGEN) proposes a series of recommendations based on current scientific evidence for a multidisciplinary approach and follow-up in primary care.

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INTRODUCTION: Patients suffering from coronavirus infection have an increased risk of venous thromboembolic disease (VTE) associated with COVID-19, which confers a higher risk of mortality. For this reason, it is necessary to analyze the knowledge and the different actions in the management of thromboprophylaxis in work environments. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection through a Google® form with 19 questions for professionals involved in the care of COVID-19. 414 surveys were received. The quantitative variables were represented with means and standard deviation and the qualitative variables with percentages and confidence intervals. RESULTS: 414 surveys analyzed. 58.2% were women. The most participatory age group was 56-65 years. 95.2% stated that COVID-19 patients had a higher risk of VTE and peripheral arterial microthrombosis. 93.6% considered that outpatient COVID-19 patients should receive thromboprophylaxis. 60.5% of the physicians did not know any protocol for the evaluation of thrombotic risk in these patients. Low molecular weight heparin was considered the main treatment for thromboprophylaxis. CONCLUSIONS: The majority of doctors consider that COVID-19 patients have a higher risk of suffering VTE and peripheral arterial microthrombosis than the general population, however more than a third do not assess the thrombotic risk and a significant percentage claim not to know protocols to evaluate said risk. The survey highlights the training needs of our professionals in thromboprophylaxis so that our patients receive healthcare with the highest possible quality.

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Resumen Objetivo: La enfermedad de Crohn es un trastorno inflamatorio idiopático de etiología desconocida con características genéticas, inmunológicas e influencias del medio ambiente. La incidencia y la prevalencia de la enfermedad de Crohn han aumentado en Colombia. El tratamiento de estos pacientes no es fácil y ha evolucionado en los últimos años; por lo tanto, es necesario desarrollar una guía de práctica clínica en Colombia, orientada al tratamiento de esta compleja enfermedad, para unificar criterios. Materiales y métodos: Esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes a la entidad y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: Se realizó una guía de práctica clínica basada en la evidencia, para el tratamiento tanto médico como quirúrgico de la enfermedad de Crohn en población adulta en Colombia. Se diseñaron algoritmos de manejo teniendo en cuenta la actividad, el comportamiento y la localización de la enfermedad. Conclusiones: Se estableció que una adecuada evaluación clínica, endoscópica e imagenológica, así como una estratificación de riesgo individual son importantes para el manejo, y se especificaron las indicaciones para el adecuado tratamiento tanto médico como quirúrgico de estos pacientes.

Abstract Objective: Crohn's disease is an idiopathic inflammatory disorder of unknown origin, influenced by genetic, immunological, and environmental factors. The incidence and prevalence of Crohn's disease have increased in Colombia. The treatment of these patients is not easy and has improved in recent years. Therefore, it is necessary to develop the Colombian Clinical Practice Guideline to guide the treatment of this complex disease and unify criteria. Materials and methods: The present guideline was carried out by a multidisciplinary team with support from the Asociación Colombiana de Gastroenterología, the Cochrane ITS Team, and the Clinical Research Institute of the Universidad Nacional de Colombia. Clinical questions regarding this disease were developed, and national and international guidelines were searched in specialized databases. The existing guidelines were evaluated in terms of quality and applicability. The Cochrane Group conducted a systematic search of the existing literature. Evidence tables were elaborated, and recommendations were made using the GRADE methodology. Results: An evidence-based clinical practice guideline was developed for the medical and surgical treatment of Crohn's disease in the adult population in Colombia. Treatment algorithms were designed, taking into account the activity, behavior, and location of the disease. Conclusions: It was established that proper clinical, endoscopic, and imaging assessment, as well as individual risk stratification, are important for treatment. Also, the indications for adequate medical and surgical treatment of these patients were specified.

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