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Arterial hypertension (AHT) is a modifiable risk factor for cardiovascular diseases, which may have an impact on perioperative complications, depending on the organ damage suffered by the patient. The perioperative management of treatment of arterial hypertension, is a mainstay in the preoperative assesment prior to any intervention. It doesn’t seem reasonable to delay surgery solely due to blood pressure values, although for patients with BP > 180/110 mmHg, the decision to perform scheduled surgeries should be carefully assessed. 相似文献
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《Actas urologicas espa?olas》2020,44(2):62-70
Introduction and objectivesThe AEU Guidelines of 2017 consider laparoscopic and robot-assisted approaches as investigational procedures. The surgical learning curve is defined as the minimum number of cases that a surgeon has to perform in order to reproduce a technique considered as standard.The aim of this study is to analyze, within our department, the implementation of a laparoscopic radical cystectomy (LRC) program compared with a well consolidated and standardized open radical cystectomy (ORC) program.Material and methodsRetrospective cohort analysis of two cystectomy groups: LRC (n = 196) (20062016) vs. ORC (n = 96) (2003-2005).Comparison of the evolution over time of the following parameters: operative time, blood transfusion rates, resection margins, postoperative complications, hospital stay and recurrence.Three time periods have been defined for LRC: implementation (2006-09) (LRC-I), development (2010-14) (LRC-D) and consolidation (2015-16) (LRC-C); comparing each of them with the control group (ORC).The chi-square test was used for the comparison of the qualitative variables and the Anova test for the numerical ones.ResultsWhen compared to ORC, LRC presented longer operative times in LRC-I and LRC-D periods. We observed a trend toward shorter operative time than ORC in the consolidation period (LRC-C).LRC also presented lower intraoperative transfusion rates in all periods and lower postoperative rates in CRL-D and CRL-C. Overall complications in LRC-D and LRC-C were lower in LRC, having fewer major complications (Clavien≥3) in the 3 periods. A decrease in mortality and hospital stay after the LRC-I phase was also observed. These results were consolidated during the two last periods of the study.We have not observed significant differences between ORC and LRC when comparing surgical margins and recurrence rates, neither in the total series, nor in the comparison between the different periods. These results endorse the oncologic safety of LRC from the beginning of the implementation process.ConclusionsWhen compared to ORC, LRC improves perioperative transfusion rates, complications and hospital stay from its implementation period, maintaining oncological safety. On the contrary, longer operative times during implementation and development were observed. However, in our series, we observed a trend toward shorter operative times than ORC approach in the consolidation period. We have validated the laparoscopic approach for radical cystectomy in our service. 相似文献
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《Actas urologicas espa?olas》2001,25(4):299-302
We report 2 new cases of testicular luxation. A review of current literature is made. Testis was located inguinal after scrotal trauma in both cases. Early close reduction was unsuccessfully. A delayed reduction was found in one case at the moment of surgery. A surgical replacement of the testis was carried out in the other patient. Follow-up control revealed a benign course in bothTesticular dislocation is a rare complication after scrotal trauma (only 152 cases reported). Physician have to be aware of this possibility following perineal trauma. Oftenly a surgery reduction is required 相似文献
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《Cirugía espa?ola》2023,101(4):238-251
Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure. 相似文献
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《Cirugía espa?ola》2020,98(4):187-203
Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60 minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels. 相似文献
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The new 8th edition of the TNM classification system for esophageal and cardia or esophagogastric junction cancer provides important innovations in the TNM stages. Two classifications are presented, updated by stages, clinical (cTNM) and pathological (pTNM) methods, together with another pathological classification applicable to cases receiving neoadjuvant treatment (ypTNM). There is a notable increase in complexity compared to previous versions, but it is still early to determine whether the current modifications will result in a clear improvement in the prognostic discrimination of survival among the patient groups (which is their main objective), although the initial expectations are favorable. 相似文献
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B. Cimadevilla Calvo C. López Sánchez J.M. Rabanal LLevot L. Sánchez Moreno 《Revista espa?ola de anestesiología y reanimación》2018,65(8):461-464
Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal.In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found. 相似文献
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M. Mayer G. Rey Valzacchi A. Silva Garretón O. Layus G. Gueglio 《Actas urologicas espa?olas》2018,42(6):414-419
Background
Congenital penile curvature is a relatively rare disease, resulting from a deviation of the penis from the body's straight axis when erect. The prevalence is difficult to determine. Although it has been suggested that the condition could affect up to 10% of the male population, most of these deviations are minor, with no clinical or psychological importance, which leads to its underdiagnosis. Effective correction of the deviation can markedly improve the quality of life of adolescents with this condition.Objective
To assess the quality of the sex life of patients diagnosed with congenital penile curvature who underwent surgical correction.Materials and methods
Design Retrospective, observational cohort study. Data was collected from the medical records of patients who underwent surgical correction of congenital penile curvature from June 2004 to August 2016. The patients completed the following self-administered questionnaires: Sexual Quality of Life Questionnaire-Male (SQOL-M), International Index of Erectile Function 5 (IIEF 5) and “How satisfied are you with the results of the surgery? From 0 to 10”.Results
Twenty-two corporoplasties were performed to correct the patients’ congenital penile curvature. The patients’ average age was 23.4 years (range, 17-35).The mean deviation prior to surgery was 47.9° (range, 20°-90°).The average score on the SQOL-M was 52 points (range, 6-66). The average score on the IIEF 5 was 22.4 points.Conclusion
Congenital penile curvature profoundly decreases quality of life, and early surgery is fundamental for repairing the anatomical deformation and thereby significantly restores the patients’ psychosocial and sexual wellbeing. 相似文献19.
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