SIOP pediatric oncology services Global Mapping Program: Latin American data collection.

The International Society of Paediatric Oncology (SIOP) launched a program to map all pediatric cancer facilities around the world. After the results in Africa were completed, the strategy for data collection for Latin America was revised to improve the accuracy and avoid duplications. In partnership with SIOP, the Sociedad Latino Americana de Oncología Pediátrica (SLAOP) approached their delegates who provided the contacts for a 10-question survey about their institutional capacities. Data were collected by email, online meetings, or telephone calls, and stored in a secure platform. All but one country participated and a high number of centers were recorded.

Malrotación intestinal en el adulto: cirugía de Ladd laparoscópica / Intestinal Malrotation in Adults: laparoscopic Ladd's Surgery

Las malrotaciones por bandas de Ladd son un subtipo de anormalidades de la embriogénesis consistentes en prolongaciones fibrosas, producto de una fijación anómala del mesenterio. Se extienden desde el ciego mal rotado hacia el retroperitoneo, pudiendo producir compresión extrínseca del duodeno. En el 90% de los casos la presentación clínica tiene lugar dentro del primer año de vida como un cuadro agudo, en forma de oclusión duodenal o vólvulo de intestino delgado con la consecuente isquemia de este o hernia interna. En la edad adulta, las formas de presentación son menos específicas. Los métodos de referencia ("gold standard") utilizados para el diagnóstico son la seriada gastroduodenal y la tomografía computarizada. El tratamiento quirúrgico consiste en la cirugía de Ladd, cuyo abordaje convencional fue descripto en 1936 por William Ladd. Presentamos el caso de un paciente adulto con un cuadro oclusivo, causado por dicha anomalía, diagnosticado de forma oportuna y resuelto de manera segura por vía laparoscópica. (AU)

Ladd's band malrotations are a subtype of abnormalities of embryogenesis consisting of fibrous extensions, product of abnormal fixation of the mesentery, that goes from the poorly rotated cecum towards the retroperitoneum, which can cause extrinsic compression of the duodenum. In 90% of cases, the clinical presentation takes place within the first year of life, as an acute condition, like duodenal occlusion or small bowel volvulus with its consequent ischemia or internal hernia. In adulthood, the forms of presentation are less specific. The gold standard methods used for diagnosis are gastroduodenal series and computed tomography. Surgical treatment consists of Ladd's surgery, whose conventional approach was described in 1936 by William Ladd. We present ta case of an adult patient with an occlusive presentation, given by this anomaly, diagnosed in a timely manner and safely resolved by laparoscopic approach. (AU)

Totally Laparoscopic Mini-ALPPS Using a Novel Approach of Laparoscopic-Assisted Transmesenteric Portal Vein Embolization.

BACKGROUND: The initial mortality rates of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) were high. However, recent data from the International Registry show a continuous reduction of early mortality and major morbidity due to risk adjustment in patient selection and less invasive techniques in stage-1 surgery. During the first ALPPS International Consensus in 2015, we introduced a paradigm inversion of ALPPS, the so-called "Mini-ALPPS." METHODS: We combined a partial liver partition with a novel technique of laparoscopic-assisted percutaneous cannulation of the inferior mesenteric vein for intraoperative transmesenteric portal vein embolization. We report here for the first time, a case of a successful totally laparoscopic Mini-ALPPS, and describe in detail the technical aspects of this new approach. RESULTS: A 61-year-old man with a 6 cm hepatocellular carcinoma compromising the right glissonian pedicle in a fibrotic liver was treated by an extended right hepatectomy using the laparoscopic Mini-ALPPS approach. The patient had an uneventful first stage and was discharged 3 days after. A CT scan performed on postoperative day 8 showed sufficient future liver remnant volume after a 59% hypertrophy. An extended right hepatectomy was uneventfully completed and the patient was discharged 5 days after surgery. The histopathological analysis indicated advanced F4 liver fibrosis and negative tumor margins. CONCLUSIONS: This technical innovation allows avoiding a laparotomy to access the mesenteric venous territory and the risks of liver remnant injuries during percutaneous transhepatic approach. This new alternative may result of great utility not only in ALPPS but also for many different circumstances and scenarios.

Eficacia del consejo antitabaco en Atención Primaria. Nuestra mejor arma / Efficacy of advice against smoking in Primary Care. Our best weapon

Fundamento: El consejo antitabaco aumenta la probabilidad de que nuestros fumadores dejen el tabaco. Cuanto más intenso, mayor es la eficacia. Objetivo: Estimar la eficacia de nuestro protocolo de intervención(PDM) basado en el Conjunto Mínimo de Datos del Fumador(CMDF), respecto al Consejo simple (CS), como ayuda para el abandono del tabaco de nuestros pacientes. Material y método: Muestra aleatoria y representativa de la zona básica del Centro de Salud Felipe II de Móstoles (Madrid) de 227 pacientes, 71 de ellos fumadores (19/71 incluidos en la Cartera de Servicios de Atención Primaria, como grupo de riesgo cardiovascular (GRCV)). Análisis de las historias médicas abiertas, para determinar en función del tipo de intervención sobre el tabaquismo de los pacientes (ninguna, CS o PDM) durante los 28 meses del estudio, el porcentaje de abandonos y de recaídas, los meses desde la intervención hasta la cesación del tabaco y los meses de abstinencia. Estimación de proporciones y medias, odds ratio (OR) en fumadores según el tipo de intervención, estratificadas por sexo, y pertenencia o no a GRCV. Resultados: El 56,17% de los fumadores recibieron consejo antitabaco: el 24,66% como PDM, el 31,51% como CS y en el 43,84% no consta ninguno de ellos. El 21,91% de los pacientes dejaron de fumar, recayeron el 9,67%. Se incorporaron al tabaquismo un 5,50% de nuevos fumadores. La probabilidad de abandonar el tabaquismo es mayor en los hombres OR (hombre/mujer) = 3,5; y en fumadores con riesgo cardiovascular añadido OR (GRCV/sanos) = 2,63. La OR PDM/CS es 3,69. Conclusiones: Nuestro PDM es eficaz como instrumento en la intervención sobre pacientes fumadores, al ser más intensa consigue mejores resultados que el consejo simple (AU)

Background: Counselling from Primary Health Care specialists may achieve better results in assisting patients to stop smoking. Objectives: Determine the effectiveness of direct, thorough counselling with help of our Minimum Data Protocol (MDP) as opposed to the more widespread generic advice. Data collection means and analysis: Random sample of 227 patients(+ 16 years old) from the Felipe II Primary Health Care Centerat Móstoles, Madrid, 71 smokers (19 presence in other cardiovascular risk groups). The choice of data to be collected was taken based on theRecommendations on the Diagnostic and Therapeutic Approach toSmokers (RDTAS) and were added: age, sex, kind of counselling (brief counselling, thorough and MDP, or no advice at all), presence in other cardiovascular risk groups, together with rate of smoking cessation, new smokers, smoking relapse, months of abstinence, time lapse between last interview and smoking cessation. Upon these data we estimated ratios, averages and odds ratios (OR) with a 95% Confidence Interval. Main results: 1) 56,17% of smokers were given advice for smoking cessation. 31,51% were given brief advice, 24,66% using MDP and43,84% were not advised at all. 2) The rate of smoking cessation was of21,91%; the rate of new smokers was of 5,50%; and the relapse ratio9, 67%. 3) Man/woman ratio of smoking cessation odds: 3,50; cardiovascular risk group OR: 2,63; MDP/ brief counselling OR of 3,69. Conclusions: Our statistical analysis proves that the usage of thisMDP works as a better means of assisting smokers in their attempt to stop smoking, than the mere advice which is already common use. We have seen that the more strong and individualized the counselling is, the better its results are (AU)