Besoins de clarification des modalités de surveillance des cancers extracoliques de la maladie de Lynch

Lynch syndrome is associated with increased risks of non-colonic cancers in several sites such as uterus, bladder, stomach, small intestine and biliary tract. There are today enough evidence to recommend systematic screening of uterus, stomach and urinary tracts but follow-up strategies need to be clarified.     

Une cause de difficulté de sevrage de la ventilation artificielle: la polyneuropathie de réanimation

Three cases of Critically Illness Polyneuropathy (CIP) are reported. The difficulty of weaning the patients from the ventilator, whereas sepsis and MOF had been successefully treated, was the main feature in the three cases. The diagnosis was established by electromyogram, showing a primary axonal denervation of peripheral nerve fibres, which was confirmed by a pathological study in one patient.     

Complicaciones de una serie consecutiva de 133 casos de prostatectomía radical

ObjetiveTo evaluate the surgical complications of radical prostatectomy in our hospitalPatients and methodFrom august 1991 to december 1999, 138 patients with clinicaly localized prostate cancer underwent Walsh technique radical prostatectomy. The follow-up is known from 133 patients with a mean age of 64,8% and a mean PSA of 17,6 ng/mlResultsThe mean follow-up is 43 months. Urinary fistula (9%), lymphatic leakage (5,22%) and rectal injury (2,2%) are the most common early complications. Urinary incontinence (27%), erectly dysfunction (98%) and uretrovesical junction stenosis (12%) are the delay complications. Only three patients have died due to prostate cancer. Our results are compared with another seriesConclusionsThe morbidity of radical prostatectomy is very similar to the compared series. Urinary incontinence and erectly dysfunction are the most worrying complications which the patient must know to have the opportunity to choose another therapeutic option     

Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo

Introduction

Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery.

Desflurane et erreurs de sélection de l'agent sur le moniteur de vapeur

With monochromatic infrared gas spectrometers (MIS), the displayed concentration is computed from measured IR absorption and a gain factor specific for the selected volatile agent (VA). As MIS cannot detect which VA is actually present, the displayed concentration can be very different from the actual one. As bottles and vaporizers are very specific for desflurane, it is impossible to misfill a vaporizer;however an erroneous selection of VA on MIS remains possible. The aim of this study was to assess the displayed concentrations after erroneous vapour selection on the monitor. When either desflurane, or isoflurane or enflurane were delivered at constant concentrations, all VA measured by the MIS, namely desflurane, sevoflurane, isoflurane, enflurane and halothane were successively selected and the displayed concentrations compared with the actual vapour concentration using a Capnomac^™ Ultima (Datex) monitor.Consequences of erroneous selection can be included in three categories: 1) dangerous error, when a displayed concentration is much lower than the actual one, eg desflurane or sevoflurane erroneously selected;2) evident error, when displayed concentration is much higher than 10 vol%;3) inconfortable situation, when displayed and actual concentrations are similar, eg isoflurane erroneously selected instead of desflurane. This error can only be detected by a careful checking of the device.     

Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature

Background and purposeParagangliomas of the cauda equina are rare tumors. The standard treatment is surgical resection. Our study aims to compare our clinical, radiological, prognostic data to the literature and to offer management and follow-up recommendations.MethodsIn this retrospective study, six patients with paraganglioma of the cauda equina region were treated. Symptoms included radicular nerve pain and low back pain with occasional sphincter dysfunction and motor deficit. MRI showed well-circumscribed lesions with homogeneous enhancement following gadolinium injection. Treatment involved complete surgical resection of the tumor under electrophysiological control. In addition to the characteristics of the tumor, we assessed operating results as well as postoperative morbidity and follow-up.ResultsAll patients had complete removal of the tumor, which required in most cases the resection of the carrying root. The intervention allowed a regression of the initial symptoms, with possible postoperative regressive sphincter disorders. Clinical and radiological follow-up (19 months on average), showed no tumor recurrence.ConclusionsThe reference treatment of these tumors is complete surgical resection, usually requiring the sacrifice of the carrying nerve root. Intra-operative nerve roots stimulation is recommended to reduce the risk of motor deficit linked to this radical treatment. A long-term clinical and radiological follow-up is recommended.     

Adquirir habilidades no manejo de crises de hipertermia maligna: comparação de simulação de alta‐fidelidade versus estudo de caso em computador

Introduction

The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer‐based case solving self‐study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents.

少女de饮食

进入青春期的少女,生理和心理上的变化都很大,她们热情好动,身体突变,体重激增。这时在膳食方面就需要多吃各种营养丰富的食品,如肉、蛋、奶、鱼、蔬菜、水果等。如果少女在青春期营养不足,势必造成身体发育不良,如身材矮小、瘦弱、月经来迟等病症。如果营养过剩,则会发育成“胖墩”,或诱发其它疾病。少女饮食最重要的是要平衡营养,切忌偏食。所谓平衡营养是指摄取的食物能够补充身体发育所需的热量和营养素,且摄取的营养素比例适当,摄入和消耗保持平衡。根据平衡营养的特点,只有将多种食物混合食用,才能取长补短。所以,少女在主食方面,应食五谷杂粮,干稀饭搭配;在副食方面,宜蔬菜与肉类搭配,豆制品与蔬菜或肉类合食,此外,还要多吃新鲜水果,但不宜多吃零食,如     

Tratamiento quirúrgico de los leiomiosarcomas de vena cava. Serie de casos en un hospital de tercer nivel y revisión de la literatura

IntroductionPrimary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles.MethodsA series of six cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out.ResultsOptimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavography was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3±9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9±2 months.ConclusionThe diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.