Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia.

BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

[Efficacy of magnetotherapy in hand erosive osteoarthritis. A clinical trial]. / Eficacia de la magnetoterapia en artrosis erosiva de manos. Un ensayo clínico.

INTRODUCTION: Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated. METHOD: Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed. RESULTS: 29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: -2.1 (95% CI: -5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects. CONCLUSION: Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement.

Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study.

AIMS: Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. METHODS: One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. RESULTS: The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p < 0.001). However, the intervention group lost more weight (6.8 ± 4.0 vs. 0.7 ± 1.3, p < 0.0001) and showed a greater reduction in plasma glucose, triglycerides, blood pressure and an increase in HDL cholesterol than the control group (p < 0.01-p < 0.002). In the subgroup of participants with type 2 diabetes, there was a significant reduction in HbA1c level following the intensive (p < 0.0001) but not the conventional intervention. At follow-up, weight loss still persisted in the intervention group (p < 0.0001), while it was lost in the control group. Both interventions significantly reduced blood pressure in the long term (p < 0.001). A significant reduction in daily total energy intake was observed in both groups with a greater reduction in saturated fat and a higher increase in fibre intake in the intervention than in the control group (p < 0.009 and p < 0.001, respectively). CONCLUSIONS: A 3-month intensive dietary intervention inspired to the traditional MD produced greater and more durable weight loss and improvement in cardiometabolic risk profile than the conventional intervention.

Induction Immunosuppressive Therapy Use in Deceased Donor Kidney Transplantation: 11-Year Experience in Veracruz, Mexico.

BACKGROUND: Induction therapy reduces the frequency of acute rejection and delayed graft function in renal transplantation. Basiliximab and Thymoglobulin are most commonly used agents for induction. METHODS: A retrospective study of two transplant centers in Veracruz, Mexico compared induction therapy in deceased donor renal transplantation from 2003 to 2014. Efficacy and safety outcomes evaluated were primary graft nonfunction, delayed graft function, acute rejection episodes and hospitalizations during first year, and patient and graft survival. P < .05 was considered statistically significant. RESULTS: Seventy deceased kidney donors (40 male) were studied. Mean donor age was 32.9 ± 14.3 years, mean donor BMI 25.6 ± 4.3 kg/m(2), and mean donor creatinine 1.13 ± 0.58 mg/dL. Main cause of death was trauma (62.9%). In total, 125 kidney transplantations were performed, with female predominance (53.6%) and mean age 33.8 ± 11.8 years. Of these, 66.4% used basiliximab and 33.6% Thymoglobulin. Thymoglobulin patients were significantly older, with lower weight and BMI, and were on dialysis longer than basiliximab patients. DGF was present in 19.3% of basiliximab patients vs 16.7% in Thymoglobulin patients, acute rejection occurred in 16.9% of basiliximab patients vs 19% Thymoglobulin patients. A total of 33.7% basiliximab patients were hospitalized during the first year vs 47.6% Thymoglobulin-induced patients (P > .05). Mean graft survival was 84.2 ± 5.3 months (73.8-94.7) basiliximab vs 32.4 ± 28.7 months (28.7-36.1) Thymoglobulin, Kaplan-Meier survival did not show statistically significant differences between groups (P = .276; CI 95%). CONCLUSION: Similar transplant outcomes were obtained using basiliximab or Thymoglobulin induction in our population.

Labioplastía genital, experiencia y resultados en 500 casos consecutivos / Genital labiaplasty, experience and results in 500 consecutive cases

ANTECEDENTES: La cosmetoginecología se ha instalado, no exenta de controversia, en la práctica ginecológica durante la última década. OBJETIVO: Presentar los resultados obtenidos en una serie de 500 labioplas-tías de labios menores realizadas por dos cirujanos en el curso de 10 años. MÉTODO: Estudio descriptivo del universo de labiobioplastías practicadas por dos cirujanos entre octubre de 2003 y abril de 2014. La decisión de intervención quirúrgica se basó en razones estéticas, funcionales y psicológicas, y no por una clasificación de hipertrofia de labios menores. RESULTADOS: Aproximadamente la mitad se realizó utilizando láser y la otra mitad electrobisturí, sin ventajas de alguna técnica sobre la otra, en cuanto a complicaciones, grado de satisfacción y resultado final estético. Las indicaciones fueron: estética en 95,4% de las intervenciones, funcional en 37,2% y psicológicas en 17,4%. Los resultados fueron satisfactorios en el 99% de las pacientes, según un autoreporte. No hubo complicaciones importantes y sólo en dos casos se presentó hemorragia post operatoria que requirió una sutura. El procedimiento, cuando fue único, fue ambulatorio, requiriendo no más de 8 horas de hospitalización. En esta experiencia, el 46% se asoció a otra cirugía ginecológica. CONCLUSIÓN: A nuestro parecer, la hipertrofia de labios menores, aún cuando pueda considerarse subjetiva, es una condición que merece ser corregida cuando es requerido por la paciente y que las técnicas actuales ofrecen resultados seguros y satisfactorios.

BACKGROUND: Cosmetogynecology is installed, not without controversy, in gynecological practice in the last decade. Aims: We present a descriptive study of 500 labia minora labiaplasty performed by two surgeons in the course of 10 years. METHOD: A descriptive study of the universe of labiobioplastys performed by two surgeons between October 2003 and April 2014. The decision for surgery was based on aesthetic, functional and psychological reasons and not on a classification of labia minora hypertrophy. RESULTS: Approximately, half was performed using laser, and electrocautery the other half, without any technical advantages over the other, in terms of complications, satisfaction and aesthetic final outcome. Indications for surgery were: in 95.4% of interventions, functional in 37.2% and 17.4% psychological. The results were satisfactory in 99% of patients, according to a self-report. There were no major complications and only two cases presented postoperative bleeding that required stitches. The procedure was ambulatory when it was unique, requiring no more than 8 hours of hospitalization. In this experience, 46% was associated with another gynecological surgery. CONCLUSION: In our view, the labia minora hypertrophy, even though it may be considered subjective, is a condition that should be corrected as required by the patient and the current techniques provide safe and satisfactory results.

Rejection is a strong graft survival predictor in live donor pediatric renal transplantation using cyclosporine, mycophenolate mofetil, and steroids: 5-year outcomes in a single Mexican center.

Long-term graft function and survival are of particular importance in children assuming that they have a longer transplantation life span than most adults. Because acute rejection episodes (ARE) continue to have a serious impact on graft loss, we analyzed the effects of ARE on 5-year survival and function in our population. Fifty-seven living donor kidney transplant recipients (34 males) younger than 18 years of age (13.5 ± 2.6 years; range, 5-17) were follow up for at feast 12 months using cyclosporine, mycophenolate mofetil, and steroid therapy with or without induction treatment between February 2003 and December 2010. ARE incidence during the first 12 months following transplantation was 14%. One-, 3- and 5-year serum creatinine values were 1.24 ± 0.39, 2.16 ± 2.39, and 1.76 ± 0.9 mg/dL, respectively. Mean calculated creatinine clearances (Schwartz) at 1, 3, and 5 years were 82.5 ± 24.8, 64.7 ± 24.1, and 67 ± 27.5 mL/min*1.73 m(2), respectively. Patient/graft survival rates were 96/85%, 90/72%, and 88/65% at 1, 3, and 5 years, respectively. Patients who experienced an ARE within 12 months following transplantation displayed a reduced 5-year graft survival rate (37.5%) versus those who did not (78%; P = .005). Patients who did not have an ARE during 60 months had a higher graft survival rate (76%) than those who had ARE (33%; P = .001). Patient without basiliximab induction showed a lower 5-year graft survival rate (61% vs 100%; P = not significant [NS]). ARE is an important risk factor for graft loss in the pediatric kidney transplant population.

EVALUACIÓN DEL POLICULTIVO DE BOCACHICO Prochilodus magdalenae Y TILAPIA Oreochromis niloticus UTILIZANDO SUPERFICIES FIJADORAS DE PERIFITON: EVALUATION OF THE POLYCULTURE OF BOCAChICO Prochilodus magdalenae AND TILAPIA Oreochromis niloticus USING PERIPHYTON FIXING SURFACES

La piscicultura es una actividad importante para satisfacer la demanda alimenticia de una población en crecimiento y en su práctica es necesario desarrollar tecnologías responsables con el ambiente. El policultivo de tilapia-bocachico es relevante por la importancia de estas especies a nivel nacional; tilapia por sus características zootécnicas, y bocachico por su hábito alimentario detritívoro-iliófago, recientemente visto como un pez ecológico. El cultivo basado en perifiton permitiría un sistema altamente eficiente y más limpio, pues aporta alimento natural a los peces y mejora la calidad del agua. Para evaluar el efecto del perifiton sobre el desempeño del policultivo tilapia-bocachico, se ejecutó un experimento durante ocho meses en 18 estanques de 90 m², con 2,6 tilapias/m² y 0,7 bocachicos/m², sin fertilización; como sustrato para perifiton se instalaron de forma vertical tubos plásticos (3,3 tubos/m²), que se constituyeron en una variable por evaluar. Adicionalmente, tres estrategias alimentarias fueron evaluadas: 0 (sin alimento), alimentación con ración del 20% de proteína bruta (PB) y alimentación con ración del 25% de PB. Se utilizó un diseño factorial 2x3 en bloques completos al azar con tres repeticiones por tratamiento y se analizaron datos productivos mediante ANOVA con un modelo lineal general (P < 0,05). No fueron encontrados efectos del sustrato sobre los parámetros estudiados. Hubo efectos simples de la estrategia alimentaria sobre el desempeño de los peces. Por lo pronto, puede ser concluido que la producción basada en perifiton no genera problemas en el sistema ni en los peces y que se requiere más investigación para consolidar la tecnología.

Fishculture is very important to satisfy human food demand. However, the ignorance in more efficient and environment-friendly systems is a big problem for fish farming activities. Tilapia-Bocachico polyculture is of great interest; tilapia, for the excellent productive characteristics, and bocachico for being a bottom-feeder specie, beside of the great socio-cultural value in this region. An alternative approach is the adoption of periphyton-based pond systems; periphyton can: be a food source for fish and improve water quality, thus becoming into a highly efficient and cleaner system. With the aim to evaluate the periphyton effects on performance of Tilapia-Bocachico polyculture, a trial was carried out for 8 months. Eighteen 90 m² earthen ponds were used under polyculture conditions at low stocking density (2.6 tilapia/m², 0.7 bocachico/m²). These ponds were not fertilized during the experimental period. Plastic tubes of 1.2 m and 6 cm in diameter were used vertically as periphyton substrate at 3.3 tubes/m² rate. Three alimentary strategies were used: 0 (without food), fish feed (20% protein) and fish feed (25% protein); thereby constituting a factorial experiment 2x3 in a randomized complete block with three replications per treatment. They were analyzed using ANOVA with a general linear model (GLM) (p < 0.05). There were no effects of substrates on the study variables, but simple effects of alimentary strategies on the productive parameters. Other parameters are being analyzed and it is still premature to conclude.

Caracterización del accidente con riesgo biológico en estudiantes de pregrado en facultades de salud en una institución de educación superior de Bogotá 2009-2010 / Characterization of the accident with biohazard risk in undergraduate students in health schools and in institutions of higher education of Bogotá 2009-2010

Objetivo: caracterizar el accidente por exposición al riesgo biológico en los estudiantes de las facultades de enfermería, medicina y odontología de la Institución de Educación Superior (IES) 2009-2010. Metodología: estudio descriptivo mixto y retrospectivo. Para identificar estudiantes accidentados, se aplicó por conveniencia una encuesta cerrada y autodiligenciada a estudiantes de pregrado, matriculados en las facultades participantes entre junio de 2009 y junio de 2010. Para la descripción del accidente, se empleó una entrevista semiestructurada, de participación voluntaria, mediante búsqueda activa de casos, aplicada a los estudiantes identificados como siniestrados a través de la estadística reportada por la póliza estudiantil de accidentes. Resultados: en la caracterización de la accidentalidad con exposición al riesgo biológico en el estudiante de pregrado de las facultades de salud, se encontró un porcentaje de reporte del evento por debajo de lo encontrado en otros estudios (1, 2). De los estudiantes que refirieron haber sufrido algún accidente con exposición a riesgo biológico, entre el 50% y el 72% solicitó atención de urgencias mientras que entre el 56% y el 79% refirieron haber reportado el caso a Bienestar Universitario; en lo referente al mecanismo de transmisión, entre el 56% y el 94% de los eventos referidos fueron ocasionados con material cortopunzante afectando principalmente miembro superior; el segundo mecanismo de exposición reportado fue la exposición de mucosas oculares con sangre o fluidos corporales con un 44% de eventos referidos por los estudiantes de medicina, mientras que para los estudiantes de las facultades de enfermería y odontología fue alrededor del 5%. En cuanto al sitio de ubicación del evento, los estudiantes de las facultades de enfermería y odontología refirieron una mayor proporción de ocurrencia en los centros de práctica formativa extramurales a la IES, mientras que los estudiantes de odontología refirieron una mayor frecuencia de ocurrencia en las clínicas odontológicas, ubicadas en las instalaciones de la Universidad; lo anterior se explica en virtud de la distribución geográfica de los centros de práctica formativa para cada programa académico. En el abordaje cualitativo de la descripción del accidente con riesgo biológico, se establecieron como categorías de análisis: el acompañamiento, las técnicas de procedimiento, la solicitud de atención en urgencias, el seguimiento y las lecciones aprendidas. El estudio permitió identificar que la presencia del docente en el campo de práctica facilita la atención del estudiante en el momento del evento; así mismo que los estudiantes identifican que la falta de adherencia a las normas o estándares de bioseguridad es un factor que incide en la ocurrencia del evento. Los participantes manifestaron que para ser atendidos en el servicio de urgencias, debieron desplazarse con las muestras sanguíneas del individuo fuente desde el sitio de ocurrencia del evento al de atención; el transporte de las muestras fue realizado por el estudiante, sin el debido cumplimiento del protocolo de transporte de muestras sanguíneas y ya en el servicio de urgencias, la atención tardó en promedio tres horas. El seguimiento del caso por Bienestar Universitario no es claro para los participantes del estudio y el principal temor se relaciona con la posibilidad de desarrollar en el largo plazo una enfermedad por virus de transmisión hemática y fluidos corporales. Se resalta que los estudiantes identifican la necesidad de modificar la práctica de medidas de bioseguridad y comprometerse con la adherencia a las normas o estándares de bioseguridad como una estrategia efectiva para evitar el accidente con riesgo biológico. Conclusiones: la IES debe fortalecer las estrategias de prevención del accidente con riesgo biológico en el marco del los convenios docencia servicio, para promover el bienestar del estudiante de las facultades de salud en el desarrollo de las prácticas formativas, de manera que se minimice el riesgo inherente a estas. Debe establecer mecanismos para asegurar el reporte de los eventos y en la misma medida favorecer la calidad en la atención al estudiante de pregrado. Se deben reforzar las estrategias que permitan a los estudiantes ser responsables de su autocuidado y a la vez permitan su adherencia a las normas de bioseguridad; ampliar el conocimiento del uso de elementos de protección y los procedimientos a seguir de presentarse el accidente.

Successful renal transplantation from a deceased donor with pesticide intoxication: a case report.

The number of individuals awaiting organ transplantation exceeds the number of organs. Patients who die from intoxication are rarely accepted as potential organ donors. Herein we have presented the results of kidney transplantations performed from a deceased 20-year-old female donor with suicidal ingestion of a pesticide (carbamate). The procured kidneys were successfully transplanted. Patients and grafts are doing well at 4 months following transplantation. There are few reports of successful transplantation of organs obtained from patients who die from various intoxications. Poisoned patients represent another pool of organ donors for transplantation services.

Evolución de los serotipos, fagotipos y resistencia a antimicrobianos de Salmonella sp en el departamento de salud 02 de la provincia de Castellón, España (2000-2006) / Evolution of serotypes, phagotypes and antibiotic resistance of Salmonella spp in the 02 health district of Castellón, Spain (2000-2006)

Retrospective study of serotypes, phage types and antibiotic resistance of Salmonella spp isolates in the 02 Health District of Castellón, Spain (2000-2006). Strains were serotyped using commercial sera, and they were tested for antimicrobial susceptibility with automated systems. Serotyping confirmation and phage typing were performed by the National Reference Laboratory. A total of 1505 strains were isolated, with 49 different serotypes, being the most frequent Enteritidis. The most common serotype/phage type combination was S. Enteritidis phagetype 1. Of the isolates 81.6 percent were susceptible to amoxicillin/clavulanic acid; 65.2 percent to ampicilin; 99.9 percent to ciprofloxa-cin; 93.4 percent to trimethoprim-sulphametoxazole; and 99.8 percent to cefotaxime. Molecular methods could be useful to complete epidemiologic studies since 25 percent of our isolates showed the same serotype/phage type combination. In our health district antimicrobial resistance in Salmonella is not an important problem.

[How to identify adverse events in emergency services? A guide agreed for the screening]. / ¿Cómo identificar los efectos adversos en urgencias? Una guía consensuada para el cribado.

OBJECTIVE: Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE. MATERIAL AND METHODS: A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques. RESULTS: Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis. CONCLUSIONS: By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies.

Reproduction of the blue-spotted maskray Neotrygon kuhlii (Myliobatoidei: Dasyatidae) in south-east Queensland, Australia.

This study examined the reproduction and population structure of the blue-spotted maskray Neotrygon kuhlii within Moreton Bay, a subtropical embayment in south-east Queensland, Australia. Mean sizes at maturity were 314 mm disc width (W(D)) in females (n = 140, 115-465 mm W(D)) and 294 mm W(D) in males (n = 123, 129-381 mm W(D)). Female N. kuhlii had a synchronous annual reproductive cycle, with one litter of one to three pups (mean +/-s.d. 1.67 +/- 0.71) produced per year. Mating behaviours were observed in October and November, and ovulation occurred early in the Austral summer, overlapping with the start of embryonic development. Gestation took c. 4 months with parturition occurring in late February and March. Size at birth was 115-170 mm W(D). The population showed a significant female bias, particularly in larger size classes. Tagging studies produced a total recapture rate of 16.1% and indicated that N. kuhlii were site resident for up to 1081 days.

Experiencia preliminar con cinta de tercera generación en el tratamiento de la incontinencia de orina de esfuerzo: MiniArc / MiniArc in the treatment of stress urinary incontinence: preliminary experience

Antecedentes: Durante la última década se han desarrollado numerosas técnicas para tratar quirúrgicamente la incontinencia de orina de esfuerzo (IOE), entre ellas las minicintas o mallas de tercera generación. Objetivos: Determinar la eficacia y seguridad del tratamiento de la IOE, mediante cinta MiniArc. Método: Estudio prospectivo, a corto plazo, de 24 mujeres ingresadas a la Unidad de Uroginecología de Clínica Las Condes, entre abril de 2008 y abril de 2009. Criterio de inclusión: IOE pura, al menos por un año, de carácter permanente y objetivada por urodinamia de monocanal. Todas debían tener hipermobilidad uretral e incontinencia de esfuerzo tipo II o II + III. En caso de prolapso genital, no debía constituir la indicación primaria de cirugía. Criterio de exclusión: Antecedente de cirugía por IOE y/o prolapso genital. Resultados: Tiempo operatorio con media de 8 minutos. Seguimiento preliminar con media de 6 meses. No hubo complicaciones en el intraoperatorio. Hubo un caso de obstrucción uretral en el postoperatorio inmediato. Al tercer 3 meses se registró un caso de urgencia de novo leve, con solución espontánea al mes de seguimiento. A los 30 días se registró cura en 23 (95,8 por ciento), mejoría en 1 (4,2 por ciento) y no hubo casos de falla. Conclusiones: El sistema MiniArc, en pacientes seleccionadas, es una técnica segura y eficaz en el tratamiento de la IOE. La incorporación de nuevos pacientes y el seguimiento a largo plazo, permitirá determinar la persistencia de estos buenos resultados.

Background: During the last decade we observed the development of numerous surgical techniques to treat stress urinary incontinence (SUI). One of these techniques is the MiniArc. Objective: To determine the efficacy and safety of the surgical treatment of SUI by MiniArc. Method: Prospective study of short follow-up, of 24 women admitted in the Urogynecology of Clínica Las Condes, between April 2008 and April 2009. Inclusion criteria: SUI at least for one year and permanent, objectified through a mono channel urodynamic. All women should have urethral hyper mobility and urinary incontinence type II or II + III. In cases with genital prolapse, it should not be the primary indication for surgery. Exclusion criteria: Antecedent of surgery for SUI and/or for genital prolapse. Results: The surgical time media of 8 minutes. The preliminary follow-up was between 1 and 13 months, media 6 months. There were no complications during the MiniArc application. In the immediate postoperative period there was a case of urethral obstruction. During the third month, there was a case of mild novo urge incontinence, which was resolved spontaneously after one month. At 30 days after surgery in 23 (95.8 percent) cure was registered, improvement in 1 (4.2 percent) and cases of failure not were observed. Conclusions: In selected patients, MiniArc is safe and effective in the treatment of SUI. The incorporation of new patients to these protocols and long term follow-up will determine the persistence of these good results.

Síndrome de Fitz-Hugh-Curtis como hallazgo durante cirugía ginecológica / Fitz-Hugh-Curtis syndrome: a case report

El síndrome de Fitz-Hugh-Curtis es una perihepatitis producida por una peritonitis secundaria al ascenso de bacterias, como resultado de una enfermedad inflamatoria pélvica. En la etapa crónica se pueden observar adherencias entre la pared abdominal y la superficie hepática, caracterizadas por la semejanza a "cuerdas de violín". Esta imagen es considerada criterio diagnóstico. Se presenta un caso de hallazgo de síndrome de Fitz-Hugh-Curtis, pesquisado durante la inspección rutinaria de la cavidad abdominopélvica, al finalizar una histerectomía laparoscópica.

The Fitz-Hugh-Curtis Syndrome is a perihepatitis secondary to peritonitis caused by ascending bacteria from a pelvic inflammatory disease. During the chronic phase may be observe adherences between the abdominal wall and the liver surface characterized by a "violin string" similarity. This image is considered criterion for the diagnosis. A case of incidental Fitz-Hugh-Curtis syndrome observed during a routinely abdo-minopelvic cavity inspection at the end of a laparoscopic hysterectomy is presented.

Infiltración de nervio pudendo guiada por tomorafía axial computada, por vía transglútea: terapia frente al dolor ocasionado por neuralgia del nervio pudendo / Transgluteal computed tomography-guided infiltration of the pudendal nerve: therapy for pain caused by neuralgia of the pudendal nerve

ANTECEDENTES: La neuralgia del nervio pudendo pocas veces es sospechada y menos diagnosticada. Por esta razón, las pacientes que la padecen, consultan múltiples veces antes de llegar a un diagnóstico definitivo. OBJETIVO: Revisar la seguridad y eficacia de la infiltración de nervio pudendo, en el tratamiento del dolor en pacientes con neuralgia del nervio pudendo. MÉTODO: Seguimiento prospectivo de cinco pacientes ingresadas bajo el diagnóstico de síndrome de atrapamiento del nervio pudendo. La edad media de las pacientes fue 45 años. Debían tener 2 criterios mayores o 1 criterio mayor asociado a 2 criterios menores. Dolor con al menos 6 meses de evolución. Sin tratamientos previos. A todas se les realizó encuesta de síntomas y signos de atrapamiento del nervio pudendo. Todas fueron infiltradas con corticoides y anestésico, guiada por tomografía axial computada. Se comparó el dolor antes y después de la infiltración con escala de 0 a 10. RESULTADOS: No hubo complicaciones durante el procedimiento. Todas disminuyeron el dolor después de la infiltración, y señalaron estar conformes con los resultados. CONCLUSIÓN: La infiltración del nervio pudendo guiada por tomografía axial computada, es una técnica segura y eficaz, en el control o disminución del dolor pelviano, ocasionado por neuralgia del nervio pudendo. Sólo el seguimiento permitirá evidenciar la mantención de los buenos resultados, o la necesidad de repetir la infiltración o de realizar cirugía de descompresión.

BACKGROUND: The pudendal neuralgia infrequently is suspected and diagnosed. Therefore the patients who suffer it consult manifold times before arriving at a definitive diagnosis. OBJECTIVE: To review the security and effectiveness of the pudendal nerve infiltration in the pudendal neuralgia treatment. METHOD: Prospective study of five patients under entrapment pudendal nerve syndrome diagnosis. The media age was 45 years old. All patients must have 2 greater criteria or 1 greater criteria associate to 2 smaller criteria. The pain must have an evolution of at least 6 months. They must not have antecedent of infiltration or surgery like treatment of this syndrome. A questionnaire of entrapment pudendal nerve syndrome was applied. The infiltration was with corticoids and anesthetic guided by CT scan. The patients classified their pain with a subjective scale; in which 0 is the pain absence and 10 is the maximum pain. The pain was compared before and after infiltration. RESULTS: Complication did not appear during the infiltration procedure. In one patient an asymmetry in the spine corresponding to the side of pain was observed. All patients diminished the pain after the infiltration. All indicated to be in agreement with the results. CONCLUSION: The pudendal nerve infiltration guided by CT scan is safe and effective technique in the treatment or diminish of the pudendal neuralgia. Only the follow-up will allow demonstrating the good results, or the necessity to repeat the infiltration, or the necessity of decompression surgery.

Desarrollo de la cirugía laparoscopica: pasado, presente y futuro: desde Hipócrates hasta la introducción de la robótica en laparoscopía ginecológica / Development of laparoscopic surgery: past, present, and future

Entendemos por endoscopia a aquellos procedimientos que permiten diagnosticar y tratar patología por medio de instrumentos con los que se observa el interior del cuerpo humano. Los primeros tratamientos por medio de endoscopia fueron realizados por Hipócrates. Luego a través de la historia son múltiples los precursores, pioneros y tantos otros que entregaron invenciones que permitieron llegar hasta el laparoscopio moderno. Convirtiéndose en una herramienta indispensable en la actual cirugía ginecológica mínimamente invasiva. Las nuevas tecnologías han permitido desarrollar la robótica, de la cual no han permanecido ajenos los procedimientos laparoscópicos. Así es como nace el robot Da Vinci, que más que una tecnología del futuro, ya constituye una realidad del presente en la cirugía laparoscópica ginecológica.

We understand by endoscope to those procedures that allow diagnosing and treated pathologies by means of instruments with which we observed in the interior of the human body. The first treatments by means of endoscope were made by Hippocrates. Soon through history the precursors, pioneers and so many others are multiple that gave inventions that allowed arriving until modern laparoscopy; becoming an indispensable tool in the present minimally invasive gynecological surgery. The new technologies have allowed developing the robotics technologies of which the laparoscopy procedures have not remained out. Thus the Da Vinci robot has born, who more than a technology of the future already constitutes a reality of the present in the gynecological laparoscopic surgery.