Seguimiento a largo plazo de la endopielotomía anterógrada. factores que influyen en el resultado

ObjectiveTo find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results.Material and MethodsWe review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10- year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed.ResultsMean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70±8.32 cm2 vs 30.19±11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0, 87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively.ConclusionEndopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results.     

¿Implica el T0 en la pieza de cistectomía encontrarse libre de tumor a largo plazo?

Introduction and objectivesThe aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved.Material and methodsWe reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression.Results12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died.ConclusionsA stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance.     

Nuestra experiencia en el manejo diagnóstico-terapéutico a corto plazo del paciente con displasia anal

IntroductionAnal intraepithelial neoplasia (AIN) is a premalignant lesion of anal squamous cell carcinoma. HIV-positive males who have sex with males, are the most affected at-risk population. Cytology and anuscopy are the best accepted methods for its diagnosis, although it is controversial which patients should complete it with a biopsy. Neither which patients should undergo treatment nor which is the best treatment is not well established. With this study, we would like to present our experience in the diagnostic-therapeutic management of AIN in the short term.MethodsRetrospective observational study of patients at risk of AIN with altered anal cytology who underwent high-resolution anuscopy with biopsy. After histological confirmation of dysplasia, they started treatment with trichloroacetic acid. Its effectiveness was verified by subsequent cytology. The demographic variables of the sample and the results of both diagnostic and treatment tests were analyzed.ResultsThe majority were HIV-positive males (104/115) and 50% had sexual relations with other men. We included 115 patients with altered anal cytology, of whom 92% had dysplasia on biopsy. 97% with atypia of uncertain significance on cytology had histological dysplasia. Cytology normalized after treatment in 60% of patients.ConclusionEarly detection of AIN should be routinely considered in known at-risk populations. Any cytological abnormality should be biopsied. Tricholoroacetic acid can be an effective treatment achieving a high percentage of regression, although currently, the information we have is of low level of evidence.     

¿Qué aporta la imagen tridimensional preoperatoria en la cirugía pancreática compleja?

The possibility of modelling diagnostic images in three dimensions (3 D) in pancreatic surgery is a novelty that provides us multiple advantages. A better visualization of the structures allows us a more accurate planning of the surgical technique and makes it easier the surgery in complex cases.We present the case study of a borderline pancreatic head adenocarcinoma patient to illustrate the advantages of 3 D modelling in complex pancreatic surgery.The help of 3 D technology allowed us to optimally plan the intervention and facilitate surgical resection. The use of this tool could translate into: shorter operative time, fewer intraoperative complications or an increase in R0 resections. The usability of the program used in our case, agile and intuitive, was an added advantage.     

Recidiva e incidencia de fístula tras el drenaje urgente de un absceso anal. Resultados a largo plazo

IntroductionAnal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess.MethodsRetrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5^th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded.ResultsMean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001)ConclusionAfter drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.     

Bloqueos diagnósticos en el manejo del paciente con lumbalgia secundaria a síndrome facetario

Low back pain is currently one of the main public health problems. Among the multiple causes, pain in the zygapophysial joints, also called facets or posterior vertebral joints, are an important cause, usually secondary to osteoarthritis. The source of low back pain is often difficult to find, making the therapeutic approach to the patient sub-optimal. Diagnostic blocks are a very important tool in establishing an adequate treatment for patients with low back pain, as long as they are performed accurately, with an adequate local anaesthetic volume, with a suitable image and fluoroscopic projection and its result are precisely interpreted. In this article a review is presented on the importance of diagnostic blocks, as well as how they should be performed in order to obtain the maximum information and the greatest therapeutic benefit.     

Textbook outcome en cirugía gástrica oncológica, ¿qué implicaciones tiene sobre la supervivencia?

IntroductionThe textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the “ideal” surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent.ObjectiveWe present a series of gastric surgery from the TO perspective and we analyze its impact on survival.MethodRetrospective observational study of all gastric neoplasms operated on in our center. Period: January 2015 - December 2020. The criteria for TO were: margins R0, > 15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group.Results91 patients were operated on. We reached the TO in 34.1% of the patients. The variable > 15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008).ConclusionIn our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance.     

Las redes sociales científicas,una nueva forma de ampliar el conocimiento. ¿Qué necesitan saber los urólogos?

Introduction and aimsNowadays, it is almost impossible not to link most of the sources of modern knowledge to information of 2.0 technologies. The aim of this review is to analyse the role of scientific social media (Sc-SoMe) and its potential applications in urology.Material and methodsA literature search was carried out using the PubMed database until July 2018. The research was performed with the following terms: “Social Media”, “urology”, “science”, “research”.ResultsSocial media (SoMe) offers integrated services and easy tools for communication, collaboration and participation. Popular prototypical platforms of SoMe are Facebook, Twitter or Instagram. SoMe not only influence private life and personal communication, but these also affect business and science sectors. In this sense, the term Sc-SoMe describes the impact and usage of 2.0 technologies platforms on scientific work. There are different models of Sc-SoMe such as author identifiers which are unique identifiers that allow managing the professional identity of each researcher, distinguishing them from other researchers and unequivocally associating their work and author profiles. This helps us manage our own academic profile and control the information available about us and ensure that other researchers are finding correct and complete information about our research and career. Examples of Sc-SoMe are: ResearchGate, ORCID, Mendeley among others.ConclusionsSc-SoMe should not only provide important information and services for literature and literature search. These could also be an important catalyst for promoting appropriate and helpful services in the context of a new concept of science, the science 2.0.     

Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo

IntroductionObesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery.Material and methodsRetrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery.Results400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < .001).ConclusionsIn a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.     

Diferencias de género en Anestesiología. ¿En qué punto nos encontramos en España? Resultados de una encuesta nacional

ObjectivePublications of diverse medical specialties confirm that gender differences still exist in the medical field. This particular study aims to investigate whether this problem exists in the specialty of Anaesthesiology in Spain.MethodsAn anonymous survey was distributed among anaesthesiologists in Spain. It had 39 questions and was designed to investigate professional position, work conditions, personal situation, and individual perceptions. The goal was to target the majority of anaesthesiologists working in Spain.ResultsCompleted surveys were received from 1,619 respondents which represents 17.6% of the total number of anaesthesiologists in Spain; 654 respondents were male (40.4%) and 965 were female (59.6%). The greater differences were found in the following areas: 70.0% of the respondents advised that their head of department is male. When asked about management and leadership positions, 25.2% of female respondents had ever had any management role in contrast to 46.1% of men (p < 0.001). Regarding academic positions, 10.3% of male respondents are university professors in contrast to only 4.8% of women (p < 0.001). 46.0% of the women surveyed believe that gender discrimination exists in the workplace whereas only 12.6% of men reported the same. A third of women (36.6%) consider their gender a barrier to promotion and fear losing their job due to pregnancy. Furthermore, both genders have witnessed patients and colleagues treating staff differently according to gender.ConclusionThe results of the survey show the existence of a gender gap among Spanish anaesthesiologists. Of particular note, women are under-represented in academic and leadership positions. Additionally, a considerable percentage of respondents perceive gender-based discrimination to be active in their workplaces. This study could serve as a template for future research in other neighbouring countries and as a means to monitor any changes in coming years.     

Bloqueo en el plano del músculo erector de la columna para mastectomía radical: ¿una nueva indicación?

The erector spinae plane block is a technique recently described by Forero et al. in September 2016. It has applications in the control of chronic pain with neuropathic component of the chest wall, and for pain control in thoracoscopic surgery. In this article, we describe the use of this technique as part of a multimodal analgesic approach in a 40-year-old woman, who underwent radical mastectomy due to breast cancer. By performing this block before anesthetic induction, we have achieved an opioid sparing effect, avoiding a possible immunomodulatory effect, although not yet proven in humans. During hospitalization, the patient reported no pain (0/10 in numeric scale), without resorting to rescue analgesia. The easy, fast and safe execution of erector spinae plane block makes it a promising technique in the context of surgical pain during radical mastectomy.