Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo

Introduction

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules.

Influencia de la experiencia previa en los beneficios del entrenamiento quirúrgico laparoscópico basado en la simulación

IntroductionSurgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience.MethodsThe students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine ‘ex vivo’ viscera were performed in a laparoscopic endotrainer.The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared.ResultsWe analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p < .001).In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p = .59), which presented improvement without statistical significance.ConclusionsThe group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.     

Manejo urológico y procedimientos quirúrgicos en migrantes del África Subsahariana con esquistosomiasis urogenital

Introduction and objectivesAn increasing number of urogenital schistosomiasis (UGS) is being diagnosed in Europe following the unprecedented migratory flux from Sub-Saharan Africa (SSA). This phenomenon represent a challenge for urologists working in a non-endemic area. The aim of this study is to describe the urological management and the surgical procedures of patients with UGS in a tertiary referral centre.PatientsAll subjects from SAA diagnosed with UGS from January 2011 to November 2018 were enrolled retrospectively. Detailed data of patients with UGS undergoing to urological procedures were collected and analysed.ResultsThirty patients were diagnosed with UGS, among them 12 (42.8%) were submitted to surgery. The most common surgical procedure was trans urethral resection of bladder (TURB) for suspected lesions persisted after praziquantel treatment performed in 7 cases (58%). Other surgical procedure were TURB and concomitant ureteroscopy with laser fragmentation for suspected bladder neoplasm with renal stone, endoscopic lithotripsy and percutaneous nephrolithotomy for bladder and renal stones, laparoscopic nephrectomy for end-stage kidney disease, placement of bilateral nephrostomy for hydroureteronephrosis, explorative testicular surgery for a suspected testicular torsion in one case each. Four patients (33%) were lost at the follow up.ConclusionAn increasing number of migrants from SSA diagnosed with UGS has been observed. Some patients required a surgical intervention for suspected neoplastic lesions or end-stage organ damage. It was particularly difficult to perform a regular follow-up in several patients. Further multicentric studies are needed to reach a proper standard in diagnosis, treatment and follow-up of subjects with UGS.     

Estado actual y evolución del manejo de la patología funcional y del suelo pélvico en los hospitales de la Comunidad de Madrid

Introduction and objectivePelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals’ resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers.Material and methodsThe survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions.ResultsThe number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP).ConclusionsMultidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.     

Mutaciones y variaciones estructurales en el gen catecol-O-metiltransferasa de los pacientes que exhiben dolor quirúrgico persistente crónico

ObjectivesMutations in the exon 4 of the COMT gene are associated with chronic persistent surgical pain (CPSP). Especially COMT mutated allele G472A (Val158Met) associated with CPSP patients is reported in different ethnic population. The purpose of this study is to evaluate the prevalence of genetic mutations and structural variations in exon 4 of COMT that can be related to the appearance of CPSP in patients under sternotomy.Materials and methodsOne hundred patients with American Society of Anesthesiologists (ASA) physical status grades i, ii and iii, who underwent sternotomy procedures, were selected to assess the development and magnitude of the CPSP evaluated with pain questionaries’ at the end of three months after surgery. This was correlated with COMT allele presence. The exon 4 of COMT gene (that contains the G472A allele) was studied. The polymerase chain reaction (PCR) products were sequenced and mutated sequences were deposited in GenBank®. The structural analysis of COMT was performed using ProCheck® and distortions of three-dimensional tertiary structural orientation was evaluated with root-mean-square deviation (RMSD) score.ResultsGenetic analysis carried out through PCR showed 220 bp amplicons. The 25% of patients with CPSP showed a Numeric Rating Scale (NRS) > 4 pain score. The 20% of these patients have known Val158Met mutation, 5% of patients showed novel mutations c.382C>G, c.383G>C, p.(Arg128Ala). The mutations in COMT gene contributed major structural variations in COMT leading to the formation of inactive COMT that correlates with CPSP.ConclusionThe results of the present study showed that both novel and previously reported mutations in COMT gene has strong association with CPSP.     

Papel de los bloqueadores de los canales de sodio dependientes de voltaje en el tratamiento del dolor crónico: usos potenciales en la práctica clínica según la evidencia disponible

Once patients have failed first line therapy, there is an apparent lack of knowledge on how to proceed with choosing subsequent therapy. To choose amongst alternative agents, an understanding of pharmacology, pharmacokinetics, and available evidence in targeting various pain conditions is necessary. This article focuses on the use of the carboxamide class of voltage-gated sodium channel blockers (carbamazepine, oxcarbazepine, eslicarbazepine acetate) for adjunct pain medication management; including research updates in pharmacology, pharmacokinetics, and evidence for pain along on this therapeutic group with promising future areas of research.Although evidence for voltage-gated sodium channel blockers in chronic pain management is limited, emerging research has identified this area as promising for additional clinical trials to better guide clinical practice.     

Dificultades en la implantación del check list en los quirófanos de cirugía

ObjectiveTo assess the level of implementation and the factors associated with the compliance to the surgical check list (SCL) proposed by the WHO, in surgery departments in public hospitals in the Murcia Region of Spain.MethodologyA retrospective cross-sectional study was conducted using a random, non-proportional, and stratified sample in each hospital. The sample size was established as 10 cases per centre, with a total of 90 surgical operations. The data analysis included the percentage of compliance of the variables of interest (presence of an SCL and the compliance to it, complete, by sections and by items) at regional level, according to hospital, hospital groups, depending on the size; the type of anaesthesia (local, regional or general); the work shift (morning or afternoon); as well as the age and sex of the surgery patients.ResultsThe check list was found in the medical records in 75 cases (83.33%; confidence interval [CI]: 78.7% - 87.5%), and complied with in full in 25 cases (27.8%; 95% CI: 18.5% - 37.0%). The percentage of items complied with was 70.1% (95% CI: 67.9%-72.2%). The percentage compliance varied by hospital, from 35.8% to 98.9%. The logistic regression analysis showed significance in the variables such as, the size of the hospital (the list was more likely to be complied with in small and medium hospitals) and operations with local anaesthetic as a negative predictive factor of compliance.ConclusionsThe SCL is used, but is not always complied with, and not homogeneously in all its sections. There is also significant variation between the public hospitals in the Murcia Region of Spain.     

Resultados de la funduplicatura laparoscópica en el tratamiento de los síntomas extradigestivos del reflujo gastroesofágico

IntroductionGastroesophageal reflux disease (GERD) can trigger typical and atypical symptoms (cough, dysphonia, asthma…). GERD with typical symptoms has well established surgical indications, but it is not the case when the symptoms are atypical. Our aim is to assess the effectiveness of laparoscopic surgery in those patients in whom the surgical indication was mainly due to atypical symptoms.Material and methodsBetween 1998 and 2011 laparoscopic fundoplication was performed on of 318 patients with GERD, of whom 14 (4%) had atypical symptoms as the main indication. Typical symptoms were present in 12 (86%) cases, and atypical symptoms were: cough in 5 (36%) cases, respiratory symptoms 5 (36%), dysphonia 2 (14%), vocal chords granuloma 1 (7%) and larynx spasm 1 (7%). The GERD diagnosis was established due to evidence of an anatomical or functional alterations of the gastroesophageal junction (hiatus hernia, pathological manometry or pH-metry). The clinical histories of the patients were reviewed and they were given a gastrointestinal quality of life (Gastrointestinal Quality of Life Index [GIQoL]) questionnaire was completed, as well as a subjective assessment (0 to 4) of the modification of their atypical symptoms.ResultsA clinical improvement was observed in both the atypical and typical GERD in 12 patients (86%), with the symptoms score decreasing from 3.7 to 0.7. A significant improvement (P<.05) from the pre-surgical value 107(± 26) to 122 (± 10) points was obtained in the quality of life (GIQoL) in 11 patients (79%).ConclusionLaparoscopic fundoplication is an effective technique in the treatment of the atypical symptoms of GERD.     

Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico

ObjectivesTo identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk.Material and methodsA group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity.ResultsA total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication.ConclusionsAccording to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units.     

Utilidad diagnóstica del estudio citológico del tampón de transporte en biopsias por punción prostática transrectal

BackgroundTo evaluate the diagnostic usefulness of the cytological study of the transport buffer in the diagnosis of prostate adenocarcinoma in transrectal core biopsies.MethodsA total of 256 consecutively biopsied patients have been included in the analysis, 100 of them diagnosed of prostate adenocarcinoma. The procedure included the cytological analysis of the transport buffer and conventional histology. Cytological evaluation was performed in a blind way by the same pathologist.ResultsOverall sensitivity, specificity, and positive and negative predictive values to detect malignancy in the cytological slides were 54%, 98%, 94% and 76%, respectively. When restricted the analysis to cases with Gleason score higher than 8, sensitivity and negative predictive value increased to 85% and 97%, respectively. Similarly, when the analysis focused exclusively to cases with more than 5 mm of cancer in the biopsy, sensitivity and positive predictive value increased to 66% and 96%, respectively.ConclusionsThis study shows that whilst specificity was maintained in 98%, sensitivity, and positive and negative predictive values significantly improved in high grade and high volume adenocarcinomas. Our findings confirm that the cytological study of the transport buffer may complement the histology in the diagnosis of prostate adenocarcinoma.