[Choice of therapeutic approach in acute cholecystitis in the elderly]. / Elección de la conducta terapéutica en la colecistitis aguda del anciano.

BACKGROUND: Acute cholecystitis in elderly patients is a common disease characterized by a high mortality rate and serious complications. AIM: To compare conservative vs. surgical therapy for acute cholecystitis in the elderly. METHODS: This is a retrospective study including patients 70 years-old or older with the diagnosis of acute cholecystitis (AC) treated between 2003 and 2009. Epidemiological and clinical data, diagnostic approach, surgical variables and cost-effectiveness were analyzed. According to the first therapeutic intent, the analysis was performed among final treatment groups and among older than 80 years and younger cases. p < 0.05 was considered significant. Statistical analysis was performed with StatView(©) 5.0. RESULTS: During the six-year period 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with a mean age of 80.6 years (range 70-101). In 103 cases medical treatment was taken, with 82 cases of resolution of the clinical picture, 15 unexpected operations and 6 deceases. Other 70 cases were undergone surgery as first option, 78.5% of them through laparoscopy with a conversion rate of 19.7%. CONCLUSIONS: In our study, surgery and medical treatment get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy. We recommend performing emergency surgery in high-risk elderly patients rather than conservative therapy due to a tendency to increase morbidity with later approach.

[Diagnostic performance of mammography in patients with clinically impercetible tumors. Analysis of 1005 tumors]. / Rendimiento diagnóstico de la mamografía en pacientes con lesiones clínicamente ocultas. Análisis de 1005 lesiones.

UNLABELLED: Breast cancer is an important public health problem. Early diagnosis is the only method of efficient secondary prevention in the control of the illness as it permits rapid and effective treatment. The objective of this study was to carry out a methodical analysis that would enable us to increase the diagnostic performance of the mammogram and to diminish the number of unnecessary surgical biopsies. MM: We selected impalpable mammary tumors in patients with radiological suspicion of breast cancer, on which surgical biopsy by harpoon had been practiced in the Lozano Blesa Hospital, Zaragoza, between October 1991 and January 2005. RESULTS: We analyzed a total of 1005 tumors in 965 patients, with an average age of 57 years. In our series of 1005 tumors, 40% were PVV. CONCLUSIONS: The diagnosis of radiological suspicion and the indication for biopsy or mammographic control are subjective and personal appreciations, but based on the systematic analysis of radiological signs of incipient tumors. This analysis enables us to establish a cut-off point to include the tumors in BIRADS.

[Quality analysis of the statistical used resources (material and methods section) in thesis projects of a university department]. / Análisis de calidad de los recursos estadísticos (sección material y método) en los proyectos de tesis de un departamento universitario.

INTRODUCTION AND OBJECTIVES: Studies about quality in thesis and investigation projects in biomedical sciences are unusual, but very important in university teaching because is necessary to improve the quality elaboration of the thesis. The objectives the study were to determine the project's quality of thesis in our department, according to the fulfillment of the scientific methodology and to establish, if it exists, a relation between the global quality of the project and the statistical used resources. MATERIAL AND METHODS: Descriptive study of 273 thesis projects performed between 1995-2002 in surgery department of the Zaragoza University. The review realized for 15 observers that they analyzed 28 indicators of every project. Giving a value to each of the indicators, the projects qualified in a scale from 1 to 10 according to the quality in the fulfillment of the scientific methodology. RESULTS: The mean of the project's quality was 5.53 (D.E: 1.77). In 13.9% the thesis projects was concluded with the reading of the work. The three indicators of statistical used resources had a significant difference with the value of the quality projects. DISCUSSION: The quality of the statistical resources is very important when a project of thesis wants to be realized by good methodology, because it assures to come to certain conclusions. In our study we have thought that more of the third part of the variability in the quality of the project of thesis explains for three statistical above-mentioned articles.

[Graves' disease with associated thyroid nodules (nodular Graves' disease). Clinical, diagnostic and therapeutic considerations]. / Enfermedad de Graves-Basedow con nódulos tioideos asociados (enfermedad de Graves-Basedow nodular). Consideraciones clínicas, diagnósticas y terapéuticas.

BACKGROUND: Sometimes Graves disease (GD) can appear in association with thyroid nodules, which seems to increase the risk of carcinoma. In this article, we try to establish clinical characteristics, diagnostic means and appropriate treatment for Graves patients with co-existent nodules. METHOD: A retrospective study was made of 153 consecutive patients who underwent operation for GD between 1967 and 2000. Each patient was subject to a regular protocol including physical examination, diagnostic test, total or subtotal thyroidectomy and follow-up in the long term with the purpose of making a valuation of the postsurgical morbidity, evolution and relapses. Data were processed through computing in order to get the statistical information. RESULTS: 28.1% of GD had thyroid nodules and carcinoma was diagnosed in four patients (9.3%), all of them belonging to papillary variety. Surgery consisted of 57 subtotal thyroidectomies (37.3%) and 94 total thyroidectomies. Parathyroid and recurrent morbidity was established in 4.6 and 3.9%, respectively, a year later since the operation, though it had a strong tendency to decrease from 1980. 96% of cases showed no relapse. CONCLUSIONS: Nodular GD is very common in our setting, especially in Graves patients with late beginning who wait for ages until they are undergone surgery. Initial treatment should be by means of braking therapy with antithyroid drugs and clinical, cytologic and ultrasonographic control. Surgery would be advised, from the outset or during the follow-up, in view of either any suspicion about cancer or presence of local growth. The procedure of choice is total thyroidectomy performed with low morbidity.

[Perforated sigmoiditis. Experiences with 805 cases. A multicenter study]. / Sigmoiditis perforadas. Experiencia de 805 casos. Estudio multicéntrico.

This was a multicenter study corresponding to 40 services. For each patient, a card containing 90 questions was filled out. At the same time we sent a personal survey card with 11 criteria questions. Our cases corresponded to 805 patients, 457 males and 348 females. The highest frequency was between 50-80 years. The therapeutic methods most often used were: drainage plus Hartmann, 37.1%; drainage plus colostomy, 24.9%; resection and anastomosis without colostomy, 12.45%, and with colostomy, 5.11%; drainage plus exteriorization, 5.98%, and conservative, 4.6%. We studied the morbimortality correlation according to different anatomoclinical groups and techniques used. The results were nonsignificant for mortality and statistically significant for evisceration, eventration, diffuse peritonitis, upper gastrointestinal bleeding, anastomotic dehiscence and type of anastomosis, manual or instrumental.

[Cancer of the surgically treated stomach: 46 cases. II: Therapeutic and survival aspects]. / Cáncer en el estómago operado: 46 casos. II parte: Aspectos terapéuticos y de supervivencia.

We made a retrospective study of stomach cancer operated in 46 cases between 1971 and 1988, based on therapeutic aspects and survival, observing that due to the generally late diagnosis of this neoplasm, the treatment, which is mainly surgical, produces a low 5-year survival rate in the majority of patients. In our series, partial gastrectomy was more predominant than total gastrectomy, and the overall 5-year survival is 11% and 13%, depending on whether postoperative mortality is included or not. We recommend the follow-up of all patients operated for benign gastric pathology, basically by endoscopy five years after the operation and throughout life, for the early diagnosis and improved prognosis of this neoplasm.

[Cancer of the surgically treated stomach: 46 cases. Etiopathogenic, diagnostic and anatomopathologic aspects]. / Cáncer en el estómago operado: 46 casos. Aspectos etiopatogénicos, diagnósticos y anatomopatológicos.

A retrospective study was made of 46 patients with operated stomach cancer (CEO) between 1971 and 1988, with respect to etiopathogenic diagnostic and pathologic aspects; it occurs most often in stomachs previously submitted to Billroth II type partial gastrectomy and there is a highly variable symptom-free interval, from 6 and 46 years in our series. The diagnosis, which unfortunately is usually late, is based mainly on gastroscopy with biopsy and/or cytology. On pathological study epithelial tumors predominate, particularly Lauren's intestinal type.