[Correction of the penile curvature in ambulatory surgery]. / Corrección del pene curvo en cirugía mayor ambulatoria.

OBJECTIVE: To evaluate the results obtained in the correction of the curved penis by means of Nesbit's technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. PATIENTS AND METHOD: From January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie's disease) by means of Nesbit's technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. RESULTS: None of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient's process. The degree of satisfaction with the received treatment has been superior to 95%. CONCLUSIONS: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patient's satisfaction.

[Systematic recording of perioperative events associated with anesthesia as quality indicator in ambulatory anesthesia]. / Registro sistemático de las incidencias anestésicas perioperatorias como indicador de calidad en anestesia ambulatoria.

OBJECTIVES: To analyze the quality of several anesthetic techniques used for major outpatient surgery in our hospital, by quantifying for each the relative risk (RR) of adverse events during anesthesia and in the postoperative period. PATIENTS AND METHODS: One thousand seventeen patients who underwent surgery between 18 May 1998 and 23 October 1998 were studied retrospectively. RESULTS: The mean age of the patients was 52.27 +/- 24.65 yr; 44.18% were ASA I, 40.56% were ASA II, 14.56% ASA III and 0.67% ASA IV. Mean time of surgery was 33 +/- 16.49 min and mean recovery time until discharge was 77.3 +/- 93.4 min. Admission was necessary for 0.6% of the patients and re-admission for 0.3%. General anesthesia was used with 19%, anesthetic monitoring with 17%, regional anesthesia (including peribulbar) with 46% and local anesthesia plus sedation with 16.6%. In 95% of the cases, no adverse events occurred during anesthesia; in 94.8% no such events occurred during the early recovery period. During surgery and postoperative recovery, intradural anesthesia was associated with significantly greater RR of adverse events in comparison with general anesthesia (6.6 and 2.2 respectively) and in comparison with monitored anesthesia (7.2 and 3.3). No differences in RR were found between general anesthesia and monitored anesthesia. Problems were slight to moderate in severity and mainly related to nausea and vomiting (2%). CONCLUSIONS: Recording perioperative events permits evaluation of the quality of anesthesic procedures. Intradural anesthesia is associated with more complications.

[Acute solitary diverticulitis of the cecum, a rare cause of acute abdomen. Apropos of 9 cases and review of the literature]. / Diverticulite aiguë solitaire du caecum une cause rare d'abdomen aigu. A propos de 9 cas et revue de la littérature.

The natural history of colonic diverticulitis rarely includes acute solitary localization in the cecum. Complications are even more rarely seen. We report retrospectively nine cases seen in our unit. There were 5 males and 4 females, mean age 54 years. The patients presented with a more or less painful abdomen with localization in the right iliac region and signs of peritoneal irritation. Physical examination revealed a painful mass in this zone. Fever and hyperleukocytosis were not found in all patients. Barium enema demonstrated signs of pseudocompression of the cecum in four cases suggesting a tumoral formation in two and diverticulitis in the two others. A right hemicolectomy was performed in five patients as peroperative pathological diagnosis could not be ascertained on the macroscopic specimen. Diverticulectomy in the four other patients was unsuccessful in direct relation with the disease course and late diagnosis.