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     

Tromboelastometría como guía de administración de hemoderivados en cirugía cardiaca

Objective

Thromboelastometry is a viscoelastometric method for haemostasis testing in a whole blood sample. The aim of this study was to assess the results of using thromboelastometry as guidance for blood management in cardiac surgery, postoperative adverse events and ICU stay.

Aplicación de la metodología Lean healthcare en un servicio de urología de un hospital terciario como herramienta de mejora de la eficiencia

Objective

To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital.

Cirugía bariátrica de conversión por fallo de la técnica inicial: 25 años de experiencia en una Unidad especializada de Cirugía de la Obesidad en España

ObjectivesTo evaluate the effectiveness of conversion surgery in a bariatric surgery unit with 25 years of experience.MethodRetrospective observational study of patients with type II obesity or higher who were reoperated by means of conversion surgery due to weight regain, residual body mass index (BMI) >35 kg/m² or < 50% of excess weight loss. The demographic and anthropometric data, comorbidities and perioperative data were analyzed in 5 periods of time: initial, post-surgery1, pre-surgery2, post-surgery2 and current.ResultsA total of 112 patients were included, with a mean age of 40.2 years, who initially underwent vertical banded gastroplasty (VBG) (32.1%), gastric banding (GB) (23.2%), Roux-en-Y gastric bypass (RYGB) (21.4%) and sleeve gastrectomy (SG) (23.2%). The conversion techniques, with a median time between the two surgeries of 70 months, included: RYGB, SG, one-anastomosis gastric bypass (OAGB), shortening of the common loop (SCL) and biliopancreatic diversion (BPD). There was a reduction of the initial weight from 144.2 ± 30.3 to 101.5 ± 21.8 kg after surgery-1; from 115.6 ± 24.0 to 91.5 ± 19.0 kg after surgery-2. The weight at present is 94.7 ± 16.4 kg, with a median follow-up of 27.5 months. Similar results were seen with the BMI. The improvement of comorbidities mainly occurred after the first intervention.ConclusionsConversion surgery causes a weight reduction that does not exceed the loss achieved after the first surgery; however, it does manage to stabilize weight over time. The perioperative morbidity rate is acceptable and would justify its application, despite the limited impact on comorbidities.     

Protocolo de manejo de la vía aérea difícil. Implicación de la Declaración de Helsinki

The “Helsinki Declaration on Patient Safety in Anesthesiology” highlights the management of the difficult airway. A difficult airway management protocol includes a set of organized strategies to aid the choice of the ventilation and intubation techniques with the greatest chance of success and the lowest risk of causing injury to the patient. The aim is to guarantee oxygenation in potentially life-threatening and rapidly changing situations that require agile decision-making, thus reducing the number and severity of critical incidents and complications.     

Aportaciones de la fluorescencia a la cirugía endocrina

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.     

Perfil do uso de drogas modificadoras de doença no Registro Brasileiro de Espondiloartrites

IntroductionFew studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA).MethodsA common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ).ResultsAt least one DMD was used by 73.6% of patients: MTX by 29.2% and SSZ by 21.7%, while 22.7% used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX, p = 0.014), inflam- matory back pain (SSZ, p = 0.002), buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001).ConclusionThe use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement.     

Propuesta de algoritmo para el manejo de la vía aérea del paciente tras inhalación de humo

Smoke inhalation represents the leading cause of mortality and morbidity in burns patients. Given the injuries that can occur in the airway after this exposure, it is imperative to evaluate the need for orotracheal intubation in the emergency department and even in the place of first assistance by healthcare workers. Since the clinical signs are poor predictors of the severity of the lesion, in selected cases, it is advisable to perform a diagnostic fibroscopy. We present a case report of a patient with a smoke inhalation lesion in which the fibroscopy was determinant to proceed to intubation, and we propose an algorithm of action for the management of the airway in this type of patients.     

Experiencia de traumatismo renal abierto en un Servicio de Urología

IntroductionOpened renal trauma in urban areas reaches 15 to 20% of all renal traumas. It is mainly caused by gunshot wounds or knifes. Gunshot wounds are classified as high energy trauma and are usually associated to other organ injuries. We present our experience in opened renal trauma in the last 24 months.Material and methodsRetrospective study: patients with thoracic, abdominal and thoraco-abdominal trauma admitted to the emergency room between July 2009 and June 2011 were studied. Fourteen patients were identified with opened renal trauma, with diagnostic confirmation by imaging study or during surgery.ResultsAges ranged from 16 to 37 years, with a mean age of 24.5 years. Thirteen patients were males. The mechanism of injury was produced by gunshot in 71% (10/14) and by knife in 29% (4/14). The opened renal traumas were classified according to the American Association for the Surgery of Trauma. Of these, 3/14 (21%) belonged to grade II, 4/14 (29%) to grade III, 4/14 (29%) to grade IV and 3/14 to grade V (21%). Fall in hematocrit ranged from 1% to 27%, with an average of 13.9%. Expectant management was done in six patients, however, this management did not take into account those surgeries performed due to non-urologic organ injuries. Six patients (42%) required nephrectomy. Thoraco-abdominal injuries were associated in 11 patients (79%).ConclusionsDespite the low incidence of opened renal trauma, many patients are observed when other national reports are considered, probably due to the socio-cultural characteristics of this hospital.     

Hidatidosis pelviana como ejemplo de masas pelvianas de etiología dudosa

We present two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic.The first case is a 75 year-old man who reported difficulty defecating and urinating. The ultrasound revealed a large cystic pelvic mass displacing the bladder and rectosigmoid region. Computed tomography also showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, and the pelvic cyst was partially excised. The other case is an asymptomatic 75 year-old man with pelvic hydatid disease that was discovered by chance while examining a prostatic adenoma.Because he is asymptomatic, we opted for observation.The anatomical pathology study confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients remain asymptomatic.Hydatid disease must be considered in the differential diagnosis for any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although no 100% specific serological test exists, there are some radiological procedures which can help us to confirm the disease. Surgery is the treatment of choice.     

Experiencia inicial de nefrectomía derecha de donante vivo por laparoscopia

Live donor nephrectomy laparoscopic technique is now standard. However, the right side is controversial because of the short length of the renal vein and the incidence of venous thrombosis.methodsA prospective study of patients live donors since May 2006 to September 2008 in which right nephrectomy was performed by laparoscopic live donor. The placement of trocares was usual and the transperitoneal approach. Incision was used for the extraction of Gibson.ResultsOf the 10 selected patients, 1 was excluded due to conversion to open technique. The criteria for lateralization were sex, renal volume and complex vascular anatomy. 6 patients had made back-table reconstruction surgery with prosthetic vascular due to the length of the renal vein. The average operative time was 158.3 minutes and the bleeding averaged 272 cc. Warm ischemia time averaged 3.2 minutes. The average hospital stay was 1.6 days. 1 recipient presenting delayed graft dysfunctionConclusionsLaparoscopic live donor right nephrectomy offers an excellent quality of graft, being a technique feasible and safe, maintaining the principle of leaving the best kidney donor.     

Programa de ahorro de sangre en cirugía cardiaca: resultados

Objective

The main objective of the study was to evaluate the effect of implementing a blood-saving programme in patients undergoing elective cardiac surgery with an analysis of the transfusion rate and complications.

Estudio poblacional de casuística y morbimortalidad de la prostatectomía radical en España

IntroductionThere is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention.Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation.Material and methodsWe designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD).We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables.ResultsBetween 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9 ± 3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with < 500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year.ConclusionsIn national terms, morbidity and mortality rates after RP are comparable to those described in the literature. This study reveals a clear dispersion in the hospitals that carry out this intervention, showing clear differences in terms of morbidity and hospital stay between the different regions.     

Factibilidad y morbimortalidad en doscientos casos consecutivos de pancreaticogastrostomía después de duodenopancreatectomía

BackgroundPostoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications.MethodsA prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction.ResultsTwo hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥III). The primary risk factors associated with complications were age >70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]).ConclusionsIn this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age >70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF.     

Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior

ObjectivesTo find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa.Material and methodsA closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery.ResultsThe questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%).ConclusionsThe results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.