Cirugía endocrina cervical mínimamente invasiva

Minimally invasive approaches for endocrine surgery of the neck are the result of efforts by several surgeons to extrapolate to neck surgery the proven benefits of minimally invasive techniques from other regions of the body, including less pain, morbidity and hospital stay. However, the main argument that led to the introduction of these techniques was the improvement of esthetic results. Endoscopic and robotic remote-access endocrine neck approaches through small incisions have been developed over the last 25 years and are constantly being refined. The objective of this review is to determine the current state of the literature through a systematic evaluation of the different techniques available in minimally invasive endocrine surgery of the neck, either with or without remote access, by describing their main characteristics and evaluating their advantages, disadvantages and controversies, while discussing their role and future in neck surgery.     

Guía clínica de la Asociación Europea de Urología sobre tecnologías láser

ContextThe European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice.ObjectiveReview the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice.Evidence acquisitionStructured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified.Evidence synthesisDepending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure.ConclusionsIn benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.     

Síndrome urofacial de ochoa: caso clínico

An 11 year-old girl had an urinary diversión because of a complex uropathy with vesical sphincter dyssinergism. Her inexpressive face with lost eyes and forced gestures, especially when smiling –her smile looking rather like weeping- was the clue to the diagnosis of Ochoa’s syndromeShe underwent psoic bladder fixation, right ureteral reimplantation, bladder neck losening and cystostomy undiversion. At follow-up, renal function deteriorated. She has recently received a kidney transplantation in another institution, and is now symptom-free     

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.

Síndrome urémico hemolítico atípico: una complicación postoperatoria infrecuente

Introduction and objectives

Thrombotic thrombocytopenic purpura and atypical haemolytic uremic syndrome (aHUS) are acute, rare, life-threatening thrombotic microangiopathies that require swift management. We report a case of acute microangiopathic haemolytic anaemia (MAHA) presenting in perioperative setting.

Papel del antígeno prostático específico ante las nuevas evidencias científicas

ObjectiveReview the scientific evidence acquired in recent years on Prostate-Specific Antigen (PSA).Acquisition of evidenceAnalysis of the available evidence on the current role of PSA, according to a panel of experts who recorded their experience on the subject.Summary of the evidenceCurrently, PSA cannot be considered solely an indicator of the presence or absence of prostate cancer. Rather, the determination of PSA assists the urologist in indicating the most appropriate treatment for a patient with benign prostatic hypertrophic (BPH), as well as in suspecting a prostatic tumour when the PSA reading increases >0,3 ng/ml, in patients treated with 5-alpha-reductase inhibitor, over the reading achieved at six months of having initiated this treatment. Moreover, PSA is a key factor in the follow-up of patients with prostate adenocarcinoma who undergo surgery, radiation therapy or minimally invasive techniques. PSA helps to define biochemical recurrence, suggest the existence of a local or distal recurrence and propose or rule out adjuvant therapies.ConclusionsNew data on the current role of PSA in the management of patients treated for BPH and/or prostate cancer should be taken into account.     

Manejo de síndrome hemolítico urémico atípico en la paciente gestante

Atypical uremic haemolytic syndrome is a variant of thrombotic micro-andiopathy characterized by non-autoimmune hemolytic anemia, thrombocytopenia and acute renal failure as a result of excessive activation of the complement. Up to 60% of patients have mutations in the genes that encode the complement system. A disensing factor is required for its manifestation, including gestation. It is an entity with a high morbidity, which can decrease drastically if an early diagnosis is made and appropriate treatment is initiated. Administration of ecuilizumab has demonstrated rapid process disruption, reducing the need for extrarenal purification therapies and improving renal function and patient prognosis.     

Guías y algoritmos para el manejo de la vía aérea difícil

The difficult airway constitutes a continuous challenge for anesthesiologists. Guidelines and algorithms are key to preserving patient safety, by recommending specific plans and strategies that address predicted or unexpected difficult airway. However, there are currently no “gold standard” algorithms or universally accepted standards. The aim of this article is to present a synthesis of the recommendations of the main guidelines and difficult airway algorithms.     

La ureterocalicostomía: ¿una cirugía olvidada?

Introductionureterocalicostomy is a surgical technique that is rarely indicated and that urologists currently apply very occasionally.Materials and methoda patient with a right pyelical retraction cicatricial process, which resulted in obstructive uropathy of the upper and mid caliceal system, excluding the lower caliceal system is presented. We performed a surgical exploration and ureterocalicostomy with successful result. In the very long term, the patient is cured and has normal kidney functionalism.Resultswe present the technical results of the surgery and, from a present-day perspective, we review the indications of this technique and the determining factors required to obtain good results.Conclusionureterocalicostomy is a technique that present-day urologists have almost forgotten, which still maintains some indications and premises effective. For this reason, urologists dedicated to reconstructive surgery must know this technique and include it in their surgical arsenal.     

Disfunción eréctil,síndrome metabólico y arteriopatía. Relación clínico-patológica mediante ecografía carotídea

IntroductionDifferent studies have shown the relationship between erectile dysfunction, metabolic syndrome and cardiovascular disease. The objective of this study was to evaluate the presence of arteriopathy performing carotid ultrasound in patients with and without erectile dysfunction.Material and methodsWe conducted a case-control study with 44 patients consulting for erectile dysfunction and 20 controls. All subjects completed the IIEF-5 test and we studied the criteria for metabolic syndrome, and a carotid ultrasound to study the intima-media thickness and the presence of atherosclerotic plaques was performed.ResultsMean intima-media thickness was .71 mm ± .21 for the right and of .71 ± .17 for the left carotid in patients with erectile dysfunction. In the control group, the means were .54 ± 0.11 and 0.59 ± 0.15 mm respectively, statistically significant differences (P = .02 and P = .05 respectively). No plaque was found in any control, but in 25% of both carotid arteries of patients with erectile dysfunction (P = .01). As metabolic syndrome, according to the American Heart Association, were diagnosed 52.8% of patients with erectile dysfunction, and 16.7% of controls, and according to the International Diabetes Federation, 52.3% of patients with erectile dysfunction and 25% of controls met diagnostic criteria. In both cases there were significant differences (P < .01 and P = .02 respectively). We found a positive linear correlation between waist circumference and the intima-media thickness in both carotid (P < .05).ConclusionsPatients with erectile dysfunction may be at increased risk of cardiovascular disease, as determined by the presence of arterial disease in the carotid arteries, which indicates that we should made a more thorough and comprehensive study of patients with erectile dysfunction.     

Intubación en dos pacientes con vía aérea difícil y estenosis traqueal tras traqueostomía en cirugía torácica

Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent^® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL^® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy.     

Nefrectomía parcial laparoscópica: estudio comparativo entre la vía transperitoneal y la vía retroperitoneal

Introduction

Laparoscopic partial nephrectomy is the recommended treatment for tumours smaller than 4 cm in cases where it is feasible. Depending on the location of the tumour, the transabdominal or direct retroperitoneal pathway may be considered.

Crisis epiléptica en el postoperatorio tardío de endarterectomía carotídea: ¿un caso de síndrome de hiperperfusión cerebral?

The so-called cerebral hyperperfusion syndrome is basically due to a lack of cerebral autoregulation, inability to control the restoring of flow after revascularisation surgery. It present clinically as intense migraine, epileptic seizures, or neurological focality. It may even progress to an intracerebral haemorrhage. It usually appears a few days after surgery. We present the case of a patient subjected to a carotid endarterectomy, who had an epileptic episode in the late post-operative period. We attributed a cerebral hyperperfusion syndrome as the most likely cause. Knowledge of this syndrome may help to correctly orientate and treat the neurological complications that appear after this type of surgery.