Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction.

OBJECTIVE: To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS: We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS: The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS: The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.

Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study.

OBJECTIVE: To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND: In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS: Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS: The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS: Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.

Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study.

INTRODUCTION: There is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm. METHODS: Patients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection. RESULTS: The sentinel lymph node technique was performed in nine patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively. CONCLUSION: The detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

[Chronic pulmonary insufficiency after tetralogy of Fallot and pulmonary stenosis intervention. Pulmonary valve replacement with mechanical prosthesis]. / Insuficiencia pulmonar crónica secundaria a tetralogía de Fallot y estenosis pulmonar intervenida. Recambio valvular pulmonar con prótesis metálica.

INTRODUCTION: Tetralogy of Fallot and pulmonary stenosis are a frequent cause of consultation in patients with congenital heart disease. Interventions performed in infancy can cause residual pulmonary insufficiency and may require pulmonary valve replacement when adults. METHODS: From 2003 to 2007, 37 patients underwent right ventricular outflow tract or pulmonary valve intervention (tetralogy of Fallot and pulmonary stenosis). Differences between echocardiographic parameters in both pathologies, indications for pulmonary valvular replacement and the type of prosthesis used, were studied. RESULTS: 25 (67.6 %) patients had tetralogy of Fallot and 12 (32.4 %) pulmonary stenosis. In the pulmonary stenosis group, 7 patients had pulmonary valvulotomy in infancy and 5 had percutaneous pulmonary valvuloplasty in adulthood. Fallot patients received a transannular patch. No significant differences were seen in echocardiographic parameters (right and left ventricular diameter, pulmonary insufficiency, transpulmonary gradient and left ventricular ejection fraction). Mechanical prosthesis valve replacement was performed in 5 (13.5 %) patients, with no morbidity-mortality and with a significant improvement of the functional class. CONCLUSIONS: Chronic pulmonary insufficiency is a frequent complication after intervention of tetralogy of Fallot and pulmonary stenosis. Mechanical prosthesis valve replacement has low morbidity-mortality and low risk of complications after short to medium-term follow-up.

[Congenital heart diseases and sports]. / Cardiopatías congénitas y deporte.

Congenital heart diseases are a frequent cause of cardiology consultation. New diagnostic and therapeutic techniques have allowed greater survival and quality of life of patients who wish to participate in sports. What they can do is not always easy to determine. Guidelines are helpful at the time of deciding, although finally is the doctor the one that must determine in each case the situation of the patient and the type of exercise they can do depending on the severity and type of cardiopathy.

[Proton pump inhibitors in paediatrics]. / Inhibidores de la bomba de protones en pediatría.

In last years the use in the pediatric area of proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) is more often, nevertheless the clinical trials carried out are poor. The aim of this work is to analyse the bibliography published about this kind of drugs in children and to make a revision of its use in the last seven years. More studies with omeprazole and lansoprazole have been developed, to be exact omeprazole and lansoprazole is present in 122 bibliographic appointments and 34 for lansoprazole, which include studies that demonstrate a good tolerance and efficacy. The remaining proton pump inhibitors count with very few studies. The main therapeutic indications were the eradication of Helicobacter pylori, gastroesophageal reflux disease and esophagitis. The number of patients included in the reviewed studies is quite heterogeneous, from 8 to 122 and the age range between 8 days and 17 years. On the other hand, it could be highlighted the non-existence of formulations adapted to the pediatric population and the difficulty of administration specially in the youngest patients. As in many other drugs, it would be necessary to carry out clinical trials in order to determinate the pharmacologic parameters at difference ages, which will allow a safe and effective administration, and its authorization by all Health Authorities.

Line defects and quantum Hall plateaus in graphene.

Line defects in graphene can be either tailored-growth or arise naturally and are at the center of many discussions. Here we study the multiterminal conductance of graphene with an extended line defect in the quantum Hall regime analyzing the effects of the geometry of the setup, disorder and strain on the quantum Hall plateaus. We show that the defect turns out to affect the local and non-local conductance in very different ways depending on the geometrical configuration. When the defect is parallel to the sample edges one gets an equivalent circuit formed by parallel resistors. In contrast, when the defect bridges opposite edges, the Hall conductance may remain unaltered depending on the geometry of the voltage/current probes. The role of disorder, strain and the microscopic details of the defect in our results is also discussed. We show that the defect provides a realization of the electrical analog of an optical beam splitter. Its peculiar energy dependent inter-edge transmission allows it to be turned on or off at will and it may be used for routing the chiral edge states.

[Drug use in neonatology units of 6 Spanish hospitals]. / Utilización de medicamentos en Unidades de Neonatología de 6 hospitales españoles.

OBJECTIVE: To determine the status of drug use in Neonatology units regarding: 1. Frequency of use for drugs unauthorised by DirecciA(3)n General de Farmacia y Productos Sanitarios. 2. Suitability of commercial presentations regarding actual needs of patients. METHOD: Two cut-off points were established for 100% of patients admitted to Neonatology Units in 6 Spanish hospitals. Data on demography and therapeutic drug profile were collected, as well as on whether doses were or not prepared by Pharmacy departments. Approval for each drug regarding indication, age range, dosage and administration route was assessed. RESULTS: The number of patients included was 346. In all, 17.6% of patients were under treatment with unauthorised drugs, the reason being age in 78.7% and indication in 21.3%. Master formula preparation was needed for 22% of patients because of a lack of commercial preparations suited for paediatric age. Pharmacy departments prepared 25% of prescribed drugs. CONCLUSIONS: The use of unauthorised drugs in Neonatology is a common fact. Pharmacy departments are actively involved in Neonatology-related drug therapies: counselling and/or processing for compassionate unauthorised drug use, master formula preparation, intravenous mixtures, etc. Therapeutics in Neonatology benefits from specialised pharmaceutical involvement.

Formação do enfermeiro para a prevenção do câncer de colo uterino / Nursing education for prevention of cervical cancer / La educación de enfermería para la prevención de cáncer de cuello uterino

Objetivou-se analisar a formação do enfermeiro para a prevenção do câncer de colo uterino no contexto da estratégia saúde da família. Estudo de abordagem qualitativa realizado com 30 enfermeiros, em Teresina, em 2013. Os dados foram produzidos por meio de entrevista, processados no Alceste 4.8 e submetidos à análise lexical pela classificação hierárquica descendente. Os resultados foram apresentados em três classes semânticas: assistência do enfermeiro na prevenção do câncer de colo uterino; educação permanente do enfermeiro para prevenção do câncer de colo uterino; e formação do enfermeiro em nível de graduação e especialização para a prevenção do câncer de colo uterino. Os enfermeiros possuem formação para a prevenção do câncer de colo uterino na estratégia saúde da família, em nível de graduação, especialização e educação permanente, no entanto, essa formação deve basear-se numa aprendizagem significativa e na possibilidade de transformar as práticas profissionais com vista às mudanças de toda a organização dos serviços de saúde.

This study aimed at analyzing the training of nurses for prevention of cervical cancer in the context of family health strategy. A qualitative study with 30 nurses in Teresina, Piauí, Brazil, 2013. Data were generated through interviews, processed on Alceste 4.8, and lexically analyzed by descending hierarchical classification. Results were presented in three semantic classes: nursing care in the prevention of cervical cancer; continuing education of nurses for prevention of cervical cancer; and nursing education at the undergraduate and expertise levels for prevention of cervical cancer. Nurses are trained for prevention of cervical cancer in the family health strategy, through undergraduation, specialization, and continuing education. However, such training must be based on meaningful learning so that professional practice can change around organization of health services.

Este estudio tuvo como objetivo analizar la formación del enfermero para la prevención del cáncer cervico uterino en el contexto de la estrategia salud de la familia. Un estudio cualitativo con 30 enfermeros, en Teresina-PI-Brasil, en 2013. Los datos se han generado a través de entrevistas, procesados en Alceste 4.8 y sometidos al análisis léxico realizado por clasificación jerárquica decreciente. Los resultados fueron presentados en tres categorías semánticas: atención de enfermería en la prevención de cáncer cervicouterino; educación continua del enfermero en nivel de pregrado para la prevención de cáncer cervicouterino; y educación de enfermería en nivel de pregrado y especialización para prevención del cáncer cervicouterino. Los enfermeros tienen una formación para la prevención del cáncer cervicouterino en la estrategia salud de la familia, a través de la graduación, especialización y formación continua, sin embargo, esa formación debe estar basada en el aprendizaje significativo y en la posibilidad de convertir las prácticas profesionales con el fin de cambiar toda la organización de los servicios de salud.

Second oestrus synchronization and precocious embryo viability after puberty induction in gilts by the use of gonadotrophin treatment.

The use of exogenous gonadotrophins in puberty inducement and ovulation synchronization is a technique that has a positive influence on the management of swine. The purpose of this study was to verify the effects of a second gonadotrophin treatment [equine chorionic gonadotrophin (eCG) and luteinizing hormone (LH), intramuscularly (i.m.)] upon the second oestrus synchronization and fertility in gilts. Seventy-one NAIMA (Pen Ar Lan) gilts had their first oestrus (puberty inducement) induced by a hormonal treatment (eCG and LH). Then, they were randomly distributed into two treatments, with (T1) and without (C) gonadotrophin treatment at the second oestrus. The animals were fed with a single ration (16% of crude protein and 3286.73 kcal ME/kg), and timed artificial insemination performed at the second oestrus. Gilts were slaughtered for embryo recovery and ovary examination about 5 days after insemination. There was no evidence of a difference in the percentage of the second oestrus expression (T1 - 90.90% and C - 86.84%), the duration of the oestrus cycle (T1 - 19.62 +/- 0.82 days and C - 19.67 +/- 4.14 days), the percentage of follicular cysts (T1 - 15.15% and C - 18.42%) and number of ovulations (T1 - 14.60 +/- 5.7 and C - 13.23 +/- 4.8) between treatments (p > 0.05). However, the hormonal treatment (T1) showed minor oestrus dispersion and embryo viability (T1 - 8.4 +/- 5.6 and C - 11.2 +/- 4.6) (p < 0.05). These results indicate that the better synchronization and expression of the second oestrus when using gonadotrophins (eCG and LH) is followed by a lower embryo viability, which is probably the consequence of the heterogeneous follicle recruitment during the injection of eCG.