Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

INTRODUCTION: Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD: This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS: Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS: The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION:  This protocol was registered at ClinicalTrials.gov (NCT03105895).

Conservative management in iatrogenic splenic trauma after chest tube insertion.

Insertar un tubo torácico es una maniobra terapéutica de gran valor, pero no exenta de complicaciones. Nuestro objetivo es poner de manifiesto una nueva opción de tratamiento mediante técnicas radiológicas intervencionistas que eviten los riesgos de una cirugía en pacientes seleccionados. Presentamos el caso de un paciente pluripatológico con diagnóstico de empiema pulmonar izquierdo al que de manera accidental se le insertó un tubo torácico en el polo superior esplénico. La comorbilidad del paciente y la presencia de estabilidad hemodinámica abogaron por un tratamiento conservador mediante cateterización esplénica supraselectiva e introducción de cola quirúrgica en la retirada del tubo.

Inserting a chest tube is a therapeutic tool of great value not without complications. Our objective is to highlight a new treatment option using interventional radiological techniques that avoid the risks of surgery in selected patients. We present the case of a multi-pathological patient with a diagnosis of left pulmonary empyema who accidentally inserted a chest tube into the splenic superior pole. The comorbidities of the patient and the presence of hemodynamic stability advocated conservative treatment through supraselective splenic catheterization and the introduction of surgical glue in the withdrawal of the tube.

Post-nephrectomy diaphragmatic hernia. Increase suspicion and decrease morbi-mortality: two cases report.

Post-nephrectomy diaphragmatic hernia is an extremely rare condition. The symptoms may be acute or latent and will depend on the herniated organ, which makes it difficult to suspect. Therefore, it is necessary to know about this type of iatrogenic hernia to avoid a delay in diagnosis. A radiological confirmation with computed tomography and early surgical treatment greatly decreased the morbidity and mortality. We report two cases: a 76-year-old male, who underwent a right nephrectomy 18 days prior due to a renal carcinoma; and a 59-year-old woman, who underwent the procedure 4 years prior due to left renal atrophy.

[Risk factors in patients older than 70 years with complicated colorectal carcinoma]. / Factores de riesgo en pacientes mayores de 70 años con carcinoma colorrectal complicado.

OBJECTIVE: The aim of this study was to analyze the outcome of patients over 70 years of age who underwent emergency surgery for complicated colorectal carcinoma, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD: A retrospective study of 54 patients older than 70 years who underwent emergency surgery for complicated colorectal cancer (42 with obstruction and 12 with perforation) between 1991 and 2002 was performed. Morbidity and mortality after surgery were studied. To determine prognostic factors of morbidity and mortality a multivariate logistic regression analysis was also performed. RESULTS: Overall and major morbidity rates were 81.5% and 42.6%, respectively. The mortality rate was 27.8%. Multivariate analysis revealed that perioperative transfusion (p = 0.014) was an independent predictive factor of major complications and that a high APACHE II score (p = 0.031) and the presence of perforation proximal to the tumor (p = 0.042) independently predicted mortality. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma in elderly patients carries elevated morbidity and mortality. The presence of risk factors should be taken into account when choosing the most suitable surgical technique and evaluating the need for intensive postoperative treatment.

[Predictive factors for malignancy in breast microcalcifications without associated lesions]. / Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas.

INTRODUCTION: Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. MATERIAL AND METHODS: We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. RESULTS: A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, > or = 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster > or = 10 mm. CONCLUSIONS: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy.