Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services.

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.

Reverse Shoulder Arthroplasty Associated With Unnoticed Glenohumeral Dislocation: A Case Report.

Osteonecrosis of the humeral head is seen in rare cases of anterior shoulder dislocations. There are many different surgical procedures that have been developed to repair inveterate anterior glenohumeral dislocation. Reverse shoulder arthroplasty (RSA) is a type of surgery that has been shown to be very effective in patients with cuff tear arthropathy. A 63-year-old female came to our service with an inveterate glenohumeral dislocation. We identified the osteonecrosis of the humeral head and decided to treat her with a reverse shoulder arthroplasty. Osteonecrosis following a glenohumeral dislocation is a rare condition. Treatment with a reverse shoulder arthroplasty allows a fast recovery, good functional results, and a better quality of life.

Radiation therapy after radical surgery in prostate cancer.

Radiation therapy plays a key role in the treatment of prostate cancer on its own. For higher risk diseases, the risk of recurrence following single modality therapy increases and a combination of treatment modalities may be necessary to achieve optimal results. We review clinical outcomes of adjuvant and salvage radiotherapy following radical prostatectomy, including disease-free survival, cancer-specific survival and overall survival. We also discuss when best to intervene with post-prostatectomy radiotherapy.

Características clínicas y prevalencia de los estados de hipercoagulabilidad en pacientes con enfermedad tromboembólica venosa / Clinical manifestations and prevalence of hypercoagulable states in patients with venous thromboembolic disease

FUNDAMENTO: La enfermedad tromboembólica venosa (ETV) puede deberse a tres mecanismos fundamentales: la estasis venosa, una alteración en el proceso de la coagulación o una lesión del endotelio. Uno o más de estos elementos constituyen los denominados estados de hipercoagulabilidad (EH), que se clasifican en primarios (EHP) y secundarios (EHS), algunos de los cuales son medibles. El objetivo fue conocer la prevalencia de EH en pacientes ingresados por ETV que cumplían criterios para realizar el estudio y las características clínicas de la embolia de pulmón en los pacientes en que se halló un EH. PACIENTES Y MÉTODO: Se practicó el estudio de trombofilia a 60 de los 175 pacientes diagnosticados de trombosis venosa profunda y embolia de pulmón que cumplían los criterios de inclusión. El análisis se realizó un mes después de terminar el tratamiento anticoagulante. RESULTADOS: Se encontró un EH en 17 de los 60 pacientes (28,3 por ciento), de los cuales 14 eran EHP y tres EHS. El EHP más frecuente fue el aumento del inhibidor del activador tisular del plasminógeno tipo 1 (PAI-1). La embolia de pulmón fue masiva en 2 pacientes con un EH, hubo recidivas en cinco y se halló afección de varios miembros de una misma familia en cinco. CONCLUSIONES: La prevalencia de EH en pacientes ingresados por ETV es alta. Las características clínicas fueron parcialmente comparables a los pacientes de otras series, y el aumento del PAI-1 fue el marcador de hipercoagulabilidad más frecuente (AU)