Comparación de dos técnicas de sección vascular en lavaricocelectomía laparoscópica. Estudio prospectivo / Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Introducción: El varicocele es la dilatación anormal del plexopampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducirhipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones,incluyendo la recurrencia del varicocele, dependiendo de la técnica deoclusión vascular utilizada: clip y sección o sellador vascular, en latécnica de Palomo laparoscópico en nuestro centro.Material y métodos: Estudio longitudinal prospectivo que se realizade 2017 a 2021. Se crean dos grupos terapéuticos según el método deoclusión vascular utilizada durante la varicocelectomía laparoscópica:clip y sección o sellador vascular. Los pacientes son incluidos en ungrupo mediante asignación sistemática consecutiva alternante. Se realizael análisis de las variables: edad, grado de varicocele según la clasifica-ción de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento yrecurrencia del varicocele, según el método empleado.Resultados: Se intervinieron un total de 37 niños, con edad mediade 12 años (10-15 años) y una media de seguimiento de 12 meses. En20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes(45,9%), sellador vascular. El 24,3% presentaba varicocele Grado IIsintomático y el 75,7%, Grado III. El 32,4% de los niños presentó algunacomplicación postquirúrgica durante el seguimiento. El 29,7% de lospacientes presentó hidrocele tras la intervención, perteneciendo 8 niñosal grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisóreintervención por este motivo. Ningún paciente presentó recurrenciadel varicocele. Conclusiones: La técnica de Palomo laparoscópica es una técnicasegura y efectiva que presenta buenos resultados en pacientes pediátricos...(AU)

Introduction: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males.Varicocele diagnosis is important since it can induce testicular hyper-trophy and fertility issues in adulthood. The objective of this studywas to assess whether complications, including varicocele recurrence,depend on the vascular occlusion technique used –clipping + divisionvs. vascular sealer–in the laparoscopic Palomo technique used inour institution. Materials and methods: A longitudinal, prospective study wascarried out from 2017 to 2021. Two therapeutic groups were createdaccording to the vascular occlusion method used during laparoscopicvaricocelectomy –clipping + division vs. vascular sealer. Patients wererandomly allocated to the groups in a systematic alternating consecutivemanner. Variables –age, varicocele grade according to the Dubin-Amelarclassification, postoperative complications, follow-up, and varicocelerecurrence– were analyzed according to the method employed.Results: A total of 37 boys, with a mean age of 12 years (10-15years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17(45.9%), the vascular sealer was employed. 24.3% had symptomaticGrade II varicocele and 75.7% had Grade III varicocele. 32.4% of thechildren had postoperative complications during follow-up. 29.7% ofthe patients had hydrocele following surgery –8 boys from the seal-ing group and 3 boys from the clipping group–, with 13.5% requiringre-intervention as a result of this. None of the patients had varicocelerecurrence. Conclusions: The laparoscopic Palomo technique is safe and ef-fective, with good results in pediatric patients and few postoperativecomplications, regardless of the vascular occlusion device used...(AU)

Estudio comparativo del control cistoscópico vs control radiológico para el tratamiento endoscópico del megauréter obstructivo primario / Comparative study of cystoscopic control vs. radiological control in the endoscopic treatment of primary obstructive megaurater

Objetivo: La dilatación neumática con balón de alta presión para el tratamiento del megauréter obstructivo primario (MOP) fue descrita inicialmente bajo control cistoscópico y radioscópico. Sin embargo, algunos grupos utilizan únicamente el control cistoscópico, con la intención de evitar la radiación ionizante asociada al procedimiento. Material y métodos: Estudio retrospectivo que incluye los MOP tratados mediante dilatación neumática en nuestro servicio entre 2008 y 2021. Comparamos tasa de éxito, complicaciones y seguimiento entre dos grupos: dilatación bajo control cistoscópico exclusivo (CS) vs control radioscópico exclusivo (RX). Resultados: Intervenimos 23 pacientes: 9 CS y 14 RX. Ambos grupos fueron demográficamente comparables. La estancia media hospitalaria fue significativamente menor en el grupo CS (1 vs 2 días; p0,009). El tiempo quirúrgico fue mayor en el grupo RX (78 vs 30 min; p0,001). La dilatación de la unión vesicoureteral (UVU) fue satisfactoria 100% CS vs 79% RX: RR 3,87 (0,51-26,99). Las complicaciones postoperatorias fueron similares para ambos grupos, RR 3,87 (0,51-26,99). La migración del catéter doble J ocurrió en un caso en ambos grupos: RR 0,64 (0,05-9,03). A largo plazo, la tasa de éxito del tratamiento fue mayor para el grupo CS (100% vS 71%); RR 3,87 (0,51-26,99). Conclusión: La dilatación neumática del MOP bajo control cistoscópico exclusivo es más rápida de realizar, sin aumentar por ello el riesgo de complicaciones. Basándonos en nuestra experiencia, proponemos eliminar la radiación ionizante a los pacientes durante el procedimiento, ya que la consideramos innecesaria.(AU)

Objective: High-pressure balloon pneumatic dilatation for the treatment of primary obstructive megaureter (POM) was initially described under cystoscopic and radiological control. However, some groups use cystoscopic control only, in an attempt to avoid the ionizing radiation associated with the procedure. Materials and methods: A retrospective study of POM patients treated with pneumatic dilatation in our unit from 2008 to 2021 was carried out. Success rates, complications, and follow-up were compared between two groups –dilatation under cystoscopic control alone (CS) vs. dilatation under radiological control only (RX). Results: 23 patients –9 CS and 14 RX– underwent surgery. Both groups were demographically comparable. Mean hospital stay was significantly shorter in the CS group (1 vs. 2 days; p = 0.009). Operating time was longer in the RX group (78 vs. 30 min; p = 0.001). Ureterovesical junction (UVJ) dilatation was successful in 100% of CS vs. 79% of RX cases; RR: 3.87 (0.51-26.99). Postoperative complications were similar in both groups; RR: 3.87 (0.51-26.99). Double J stent migration occurred in one case in both groups; RR: 0.64 (0.05-9.03). In the long-term, treatment success rate was higher in the CS group (100% vs. 71%); RR: 3.87 (0.51-26.99). Conclusion: POM pneumatic dilatation under cystoscopic control alone is faster, without increasing the risk of complications. Based on our experience, we suggest ionizing radiation be removed, since we consider it to be unnecessary.(AU)

Pseudoachalasia as a paraneoplastic event in a patient with Hodgkin’s disease

Pseudoachalasia or secondary achalasia (5% of achalasias that are deemed primary achalasias) is an esophageal motor disorder with manometric criteria for achalasia, but it appears in the context of an underlying pathology that can be attributed to its origin. Usually appears in >60 years with rapid evolution of symptoms (<1 year). The main cause of pseudoachalasia is neoformative etiology, but there are others. Our patient started with rapid progression dysphagia and was diagnosed with type II achalasia within a Hodgkin's lymphoma. In the radiological-metabolic studies, disease involvement was ruled out as an extrinsic compression of the esophagogastric junction as well as signs of its activity at this level. Chemotherapy has not been shown to play a role in the development of this pathology. On the other hand, radiotherapy has been associated with an esophageal motor disorder, but, in our case, it was after its onset. Therefore, we propose that the mechanism of pseudoachalasia in our case is a paraneoplastic event. This hypothesis is related to other similar cases reported, and it reflects the importance of continuing to investigate this clinical condition that is indistinguishable by manometry from primary achalasia. In addition, it usually presents differential clinical characteristics whose early recognition has implications for the diagnostic, therapeutic, and prognostic management of the patient. (AU)

Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2 late vaginal complications in 3D vaginal cuff brachytherapy (interventional radiotherapy) ?

Purpose Analyse the impact of different prognostic factors on G2-late vaginal complications after vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) in postoperative endometrial cancer (PEC). Methods One hundred and twenty-six PEC patients treated with VBT ± EBRT were retrospectively analysed considering age, body mass index, applicator diameter, clinical target volume (CTV), use of dilators, chemotherapy and EQD2(α/β=3) at the most exposed 2 cm3 of the CTV as prognostic factors for vaginal complications. Late vaginal complications were evaluated using objective LENT-SOMA criteria. Statistics: descriptive analysis, Chi-square, Fisher and Student tests were applied. Univariate and multivariate analyses were performed with the Baptista–Pike exact method and multiple logistic regression. Results Mean age was 65 years (SD ± 10), and median follow-up was 66 months (8–104). 19/126 patients (15%) showed G2-late vaginal complications, and 107/126 (85%) G0–G1. Univariate analysis showed: CTV ≤ 9 cm3 (p = 0.036), use of dilators < 9 months (p = 0.015), and total ≥ 68 Gy EQD2 received by 2 cm3 of CTV (p = 0.039) were associated with G2-late vaginal toxicity. Multivariate analysis showed the use of dilators < 9 months as an independent prognostic factor for G2-late vaginal toxicity (p = 0.043, OR 8.59, CI 1.59–159.9). Conclusion The use of dilators < 9 months in VBT ± EBRT for PEC was an independent prognostic factor for G2-late vaginal toxicity. The use of vaginal dilators ≥ 9 months requires further analysis in studies evaluating late vaginal toxicity (AU)

A Retrospective Multi-Center Study of the Clinical Effects of Transurethral Columnar Balloon Dilation of the Prostate in the Treatment of Elderly Patients with Benign Prostatic Hyperplasia

Introduction: The aim of this study was to explore the clinical effect of transurethral columnar balloon dilation of the prostate (TUCBDP), in the treatment of benign prostatic hyperplasia in men over the age of 60 years old. Methods: This was a retrospective multi-center study follow-up of patients with benign prostatic hyperplasia (BPH) who underwent TUCBDP. The international prostate symptom score (IPSS), quality of life score (QoL), residual urine volume (PVR), andmaximum urine flow rate (Qmax) were evaluated one and six months after the procedure. Results: All 68 patients had the operation from January 2019 to December 2021. Their postoperative IPSS, QoL, PVR, andQmax of the patients significantly improved, in comparison to before procedure (p < 0.05). The improvement rate of IPSS andQoL in the small volume BPH group was significantly higher than that in the non-small volume BPH group (p < 0.05), but had little effect on the improvement rate of PVR and Qmax. Conclusions: TUCBDP can significantly improve IPSS, QoL, PVR, and Qmax in elderly men with BPH up to six months after theprocedure, with the advantages of shorter operation time and less blood loss. The postoperative improvement effect of patientswith small volume BPH was more obvious than that of patients with non-small volume BPH (AU)

Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario / Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter

Objetivos: El megauréter obstructivo primario congénito (MOP)se produce por la estenosis de la unión ureterovesical, disminución enla peristalsis y su consecuente dilatación. Aunque actualmente el goldstandard para el tratamiento de esta entidad sigue siendo el reimplanteureteral, la dilatación retrógrada se considera una alternativa terapéuticaeficaz con buenos resultados y que está ganando cada vez más adeptos,siendo en algunos centros la técnica de elección. El objetivo es presentaruna alternativa de abordaje para su tratamiento. Material y métodos: Se presenta el caso de un lactante de 5 mesescon MOP afecto de pionefrosis que precisa nefrostomía y antibioterapiaendovenosa. La dilatación endoscópica se realizó a través del drenajepercutáneo de manera anterógrada sin necesidad de cistoscopia. Resultados: El procedimiento se llevó a cabo sin incidencias. Enel seguimiento se apreció una disminución de la ureterohidronefrosis,persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento,permanece asintomático. Conclusiones: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resoluciónde la patología.

Objectives: Congenital primary obstructive megaureter (POM) iscaused by ureterovesical junction stenosis, reduced peristalsis, and theresulting dilatation. Even though ureteral re-implantation remains thecurrent gold standard technique, retrograde dilatation is considered asan effective therapeutic alternative with good results and growing proponents – to the extent it has become the technique of choice in somehealthcare facilities. The objective was to present an alternative approachfor treatment purposes Materials and methods. This is the case of a 5-month-old infantwith POM and pyonephrosis requiring nephrostomy and intravenousantibiotic therapy. Endoscopic dilatation was carried out by means ofa percutaneous drainage in an antegrade fashion and did not requirecystoscopy. Results: The procedure was uneventful. During follow-up, uretero-hydronephrosis decreased, while ureteral dilatation persisted to a lesserextent with an adequate peristalsis and absence of secondary VUR. Thepatient has had no symptoms after an 11-month follow-up. Conclusions: POM antegrade dilatation is an effective alternativein selected patients as it makes the pathology disappear.(AU)

¿Es eficaz y seguro el tratamiento endoscópico de las estenosis de intestino delgado en pacientes con enfermedad de Crohn? / No disponible

INTRODUCCIÓN: existe poca evidencia científica sobre la eficacia de la dilatación endoscópica con balón (DEB) mediante enteroscopia en el tratamiento de las estenosis de intestino delgado (ID) en la enfermedad de Crohn (EC). OBJETIVO: evaluar la eficacia y la seguridad de la DEB mediante enteroscopia en pacientes con EC y estenosis en ID. MÉTODOS: estudio observacional retrospectivo en un centro de atención terciaria en pacientes con EC y estenosis de ID evaluadas por enteroTC o enteroRM. RESULTADOS: desde 2009 hasta 2019 se realizaron 205 dilataciones en 80 pacientes con EC; de ellos 17 (21,25 %) fueron pacientes con estenosis exclusivamente de ID (varones 70,6 %; edad media de 42,2 ± 14,4. El tiempo medio de seguimiento fue de 37,8 ± 28,7 meses. Se realizaron un total de 39 dilataciones. El 94,1 % eran nativas, con una longitud inferior que 5 cm y el 100 % estaban ulceradas. La tasa global de éxito técnico fue 82,4 %. El éxito clínico fue del 88,2 %. Durante el seguimiento, el 23,5 % de los sujetos requirieron de intervención quirúrgica (IQ), el 29,4 % de redilatación endoscópica y la eficacia a largo plazo fue del 76,5 %. No se produjeron complicaciones mayores. No se encontraron factores predictivos asociados con la necesidad de IQ tras la dilatación. CONCLUSIONES: las estenosis de ID pueden ser tratadas de forma segura y eficaz con DEB mediante enteroscopia asistida por balón (EAB) reduciend la necesidad de IQ a largo plazo

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Estenosis esofágica congénita. La sospecha diagnóstica se inicia desde Atención Primaria / Esophageal congenital stenosis. The diagnostic suspect is started from Primary Care

La estenosis esofágica congénita es una malformación rara que ocurre debido a la separación incompleta del esófago y del sistema respiratorio. Generalmente cursa con vómitos persistentes que suelen debutar o exacerbarse con la introducción de la alimentación complementaria y con ello de los alimentos sólidos. Dados los síntomas de presentación, la sospecha diagnóstica se puede realizar desde las consultas de Pediatría de Atención Primaria. El diagnóstico se realiza mediante una endoscopia digestiva alta que mostrará normalidad de la mucosa y un tránsito digestivo. Existe controversia en cuanto al tratamiento de elección, prefiriéndose el tratamiento conservador mediante dilataciones endoscópicas de inicio

Esophageal congenital stenosis is an unusual type of malformation that occurs due to incomplete division of the esophagus and respiratory system. Generally, it shows up with persistent vomiting that tends to debut or exacerbate with the introduction of complementary feeding and solid foods. A high degree of suspicion is necessary for diagnosis from Primary Care pediatricians. A high digestive endoscopy with normal mucosa and a digestive transit confirm the diagnosis. There is controversy regarding the treatment of choice, conservative treatment is preferred by initial endoscopic dilations

Endoscopic papillary large balloon dilation with minor sphincterotomy for periampullary diverticular papilla

Background To observe the outcome of endoscopic papillary large balloon dilation (EPLBD) with minor sphincterotomy (mEST) for periampullary diverticular papilla related to stone removal. Methods Patients with confirmed periampullary diverticulum (PAD) during stone removal from May 2016 to April 2018 were reviewed retrospectively. The Chi-square test with Yates correction or Fisher's exact test was used for the analysis of categorical data and a normality test was applied for continuous data. Results A total of 154 consecutive patients (89 males and 65 females, aged 51-87 years) with confirmed PAD during stone removal were included in the study. Cases were divided into the conventional EST group (n = 79) and the mEST plus EPLBD group (n = 75). The number of patients with an initial treatment success was greater in the EPLBD+mEST group compared with the EST group (96% vs 86.1%, p=0.03) and the procedure time for EPLBD+mEST was shorter than that for EST alone (46.1+/-13.7 min vs 53.3+/-11.6 min, p=0.01). The rate of complications in the EPLBD+mEST group was lower than in the EST group (17.3% vs 32.9%, p=0.04). When PAD was >15 mm, the initial success rate was higher (92.6% vs 73.9%, p=0.04) and the rate of overall complications was lower (14.8% vs 41.7%, p=0.03) in the EPLBD+mEST group than those in the EST group. Although, this was similar when PAD was <15 mm. Conclusion EPLBD+mEST might be safer and more effective than conventional EST alone for stone removal in the presence of PAD

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Dilatación endoscópica con balón de estenosis duodenal secundaria a linfoma intestinal en paciente portador de trasplante cardiaco / Endoscopic balloon dilation in duodenal stenosis secondary to intestinal lymphoma in a heart transplant patient

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¿Cómo varía la función y dilatación renal después de la cirugía de pieloplastia en edad pediátrica? / How do renal function and dilation change after pieloplasty surgery in children?

Objetivo: Los efectos de la pieloplastia sobre la función renal no están totalmente definidos. Nuestro objetivo es determinar si cambia la función renal y la dilatación renal después de la cirugía de pieloplastia y los factores que pueden influir en ambos parámetros. Métodos: Estudio retrospectivo de pacientes intervenidos de pieloplastia. Se analizaron los parámetros: edad, función renal diferencial, dilatación renal, infección y complicaciones. Se compararon los hallazgos en la ecografía con la medición del diámetro anteroposterior de la pelvis (mm) y la curva de captación tiempo/ actividad en el renograma 99m Tc- Mercaptoacetiltriglicina antes y después de la cirugía. Dividimos a los pacientes en función mala (< 20%), regular (20-40%), normal (40-55%) y supranormal (> 55%). Resultados: Se incluyeron un total de 129 pacientes, el grupo de pacientes intervenidos más frecuentemente fueron aquéllos que presentaban una función renal normal (40-55%). Al comparar la función antes y después de la cirugía, se observó una mejoría estadísticamente significativa cuando la función preoperatoria es mala < 20% (media 9,2 +/-8,9) o cuando es supranormal > 55% (media -8,7 +/- 8,5). En el subgrupo de pacientes menores de 12 meses destacó que sólo hubo resultados significativos cuando la función era regular 20-40% (media 5,6 +/- 2,2). La dilatación renal presentó cambios significativos (p < 0,0001) tras la cirugía en todos los grupos de pacientes (media -12,4 +/- 1,2), excepto cuando se habían producido complicaciones. Conclusiones: La función renal previa tuvo valor pronóstico en cuanto a resultados de la pieloplastia. La función supranormal debe considerarse patológica, pero recuperable y puede mejorar tras pieloplastia. En ausencia de incidencias intra o postoperatorias, la dilatación pielocalicial disminuyó tras la pieloplastia

Objective: The effects of pyeloplasty on renal function are not fully well defined. Our objective is to determine if renal function and renal dilation change after pyeloplasty and the risk factors that may influence in both parameters. Methods: Retrospective study of patients who underwent pyeloplasty. The parameters analyzed included: age, differential renal function, renal dilation, infection and complications. We compared ultrasound findings with measurement of the anterior-posterior diameter of the renal pelvis (mm) and the time/activity upload curve of the 99mTc- Mercaptoacetyltriglycine renography before and after surgery. Patients were divided in groups by renal function: bad (< 20%), diminished (20-40%), normal (40-55%) and supranormal (> 55%). Results: A total of 129 patients were included in the study. The normal renal function group was the one undergoing surgery most frequently. Comparison of function before and after surgery showed a statistically significant improvement when preoperative function was bad (< 20%) (mean 9.2 +/- 8.9) or supranormal (> 55%) (mean -8.7 +/- 8.5). In the subgroup of patients under 12 months, it was notable there were significant results only when renal function was diminished (20-40%) (mean 5.6 +/- 2.2). Renal dilation presented significant changes after surgery in all groups (mean 5.6 +/- 2.2) (p < 0.0001), except in cases presenting complications. Conclusions: Previous renal function has prognostic value on pieloplasty results. Supranormal renal function should be considered pathologic, but recoverable and it may improve after pieloplasty. In the absence of intra or postoperative complications, pyelocalycial dilation diminished after pieloplasty

Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones

Background and aim: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. Patients and methods: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. Results: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. Conclusion: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy

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Hidrodilatación capsular versus cinesiterapia como tratamiento inicial en las capsulitis de dedos / Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis

Introducción: Valorar la efectividad de la hidrodilatación capsular en las articulaciones interfalángicas proximales o en las metacarpofalángicas precozmente para mejorar la rigidez articular y acortar el tratamiento cinesiterápico. Secundariamente, mejorar la funcionalidad. Material y método: Estudio cuasiexperimental antes-después con grupo control de un año de duración de pacientes con capsulitis en las metacarpofalángicas o interfalángicas proximales en fase 2 o 3 del síndrome de dolor regional complejo. Se incluyen pacientes mayores de 18 años con capsulitis, sin cinesiterapia previa y con escala visual analógica<4 puntos. Realizamos hidrodilatación ecoguiada (HD) más cinesiterapia o solo cinesiterapia. Había 10 pacientes por grupo. Las principales variables son rango articular, empuñadura, escala Michigan Hand Outcomes Questionnaire y número de sesiones de cinesiterapia. Resultados: Basalmente, el rango articular de las articulaciones interfalángicas proximales fue 20° peor en el grupo experimental (p=0,01); el resto de las características basales no mostraron diferencias significativas. La ganancia inmediata con la HD es del 61,71% respecto al rango articular previo (p=0,024). No hubo mejoras significativas en la funcionalidad, excepto en la empuñadura activa, tras la HD (p=0,02) y al mes respecto al grupo control (p=0,014). En el grupo HD la duración media de la cinesiterapia es de 19,6±10,42 (IC 95%) y de 29,4±8,11 (IC 95%) sesiones en el grupo control (p>0,05). Conclusiones: La HD capsular podría considerarse como la opción inicial de tratamiento en la rigidez articular, ya que supone una mejora significativa del rango articular de forma inmediata. Es una técnica innovadora en estas articulaciones y con una rápida curva de aprendizaje, que ha demostrado ser segura y efectiva para realizar en una consulta de Rehabilitación

Introduction: To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality. Material and methods: We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required. Results: At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05). Conclusions: Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room

Hematoma subcapsular hepático tras colangiopancreatografía retrógrada endoscópica. Una complicación rara y con elevada morbimortalidad / Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography. A rare complication with high morbidity and mortality

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Endoscopic balloon dilation of oesophageal stenosis in a patient with recessive dystrophic epidermolysis bullosa / Dilatación endoscópica con balón de estenosis esofágica en paciente con epidermollis bulsosa distrófica recesiva

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Aqueduct-100, an innovative device and method for controlling cervical dilation / Aqueduct-100, innovador dispositivo y un método para la dilatación cervical controlable

Every intrauterine procedure begins with dilation of the cervix to enable insertion of surgical tools into the uterus. The 2 most common methods for this procedure (mechanical dilators and hygroscopic materials) are time-consuming or require anesthesia for the painful process of inserting metal or plastic rods of increasing diameter. Both methods expose the patient to increased risk of infection. Aqueduct-100 combines the advantages of both methods and provides safe and painless radial dilation of the cervix within minutes. The results of the study suggest that the Aqueduct-100 device should be used as an alternative to mechanical dilators to prevent injuries to the cervix and uterus during cervical dilations

Cada procedimiento intrauterino comienza con la dilatación del cuello del útero para la inserción de los instrumentos quirúrgicos en el útero. Los dos métodos más comunes para este procedimiento (dilatadores mecánicos y materiales higroscópicos) o bien toman mucho tiempo o requieren anestesia para un proceso doloroso que implica la inserción de varillas de metal o de plástico de diámetro creciente. Ambos métodos exponen al paciente a un mayor riesgo de infección. Aqueduct-100 combina las ventajas de los dos métodos y proporciona dilatación radial segura y sin dolor del cuello uterino, en cuestión de minutos. Los resultados del estudio sugieren que el dispositivo Aqueduct-100 se debe utilizar como una alternativa de los dilatadores mecánicos para prevenir lesiones uterinas y cervicales durante dilataciones cervicales

Factores asociados a complicaciones en las dilataciones esofágicas endoscópicas / Factors associated with complications during endoscopic esophageal dilation

Antecedentes: las dilataciones endoscópicas se consideran el tratamiento de elección para las estenosis esofágicas, sin embargo, no se cuenta en nuestra región con estudios en los que se evalúe la seguridad de este procedimiento. Objetivo: evaluar la seguridad de las dilataciones esofágicas y los factores asociados a las complicaciones. Material y métodos: cohorte retrospectiva. Se incluyeron todos los pacientes referidos para dilatación esofágica entre enero de 2015 y junio de 2017. Se obtuvo la tasa de complicaciones y se determinó la asociación entre la no adherencia a la "regla de los tres" y el desarrollo de complicaciones. Se analizaron otros factores predictivos asociados al desarrollo de complicaciones. Resultados: se incluyeron 164 pacientes en los que se realizaron 474 dilataciones. La etiología más prevalente fue la estenosis de anastomosis quirúrgica. Se presentaron seis complicaciones: tres perforaciones (0,63%), dos sangrados (0,42%) y un episodio de dolor significativo que requirió observación posprocedimiento (0,21%). La dilatación endoscópica esofágica fuera de la "regla de los tres" no se encontró asociada a un mayor riesgo de complicaciones. La dilatación con balón fue el único factor predictivo para el desarrollo de complicaciones. Conclusiones: la dilatación esofágica es un procedimiento seguro. La no adherencia a la "regla de los tres" no parece estar asociada a un mayor riesgo de complicaciones, incluyendo la perforación esofágica

Background: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. Objective: to assess the safety of esophageal dilation and the factors associated with the development of complications. Materials and methods: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. Results: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. Conclusions: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation