Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results.

INTRODUCTION: Enhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery. MATERIAL AND METHODS: A multidisciplinary group created the programme and the patient school (preoperative consultations where the patients' surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D). RESULTS: One hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively. CONCLUSIONS: The ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.

The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy.

INTRODUCTION AND OBJECTIVE: Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. MATERIAL AND METHODS: Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. RESULTS: 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. CONCLUSIONS: Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.

Determinación de la tasa de hospitalizaciones por complicaciones del síndrome hipertensivo del embarazo en Chile, periodo 2018 - 2021 / Determination of the rate of hospitalizations due to complications of hypertensive syndrome of pregnancy in Chile, period 2018 - 2021

Introducción: El Síndrome Hipertensivo del Embarazo (SHE) es el conjunto de condiciones patológicas derivadas del alza de presión arterial mantenida originadas antes y/o durante el curso de un embarazo. En ocasiones requiere tratamiento hospitalario. El objetivo del estudio es determinar la tasa de egreso hospitalario (TEH) por complicaciones del SHE durante el 2018-2021 en Chile. Materiales y métodos: Estudio descriptivo tipo transversal de las complicaciones por SHE en el periodo 2018-2921 en Chile según grupo etario y días de estadía hospitalaria (n=12.006). Datos obtenidos del departamento de estadística e información en salud. Se calculó TEH. No requirió aprobación del comité de ética. Resultados: La Preeclampsia tuvo más TEH con 61,48 por cada 100.000 habitantes, afectó más a mujeres de 20 a 44 años con 74.03 por 100.000 habitantes. Las complicaciones del SHE reportaron un promedio de 6,4 días de hospitalización. El Síndrome de HELLP registró más días de hospitalización con 7,2 días. Discusión: El envejecimiento poblacional, la migración, el sobrepeso-obesidad podrían influir en mayores TRH por preeclampsia. Se reportó mayores TEH de preeclampsia en mujeres de 20 a 44 años. Esto se debe posiblemente por factores cardiovasculares, maternidad tardía y la hipertensión crónica. El Síndrome de HELLP implica peor pronóstico y reportó mayores días hospitalización debido al manejo médico. Discusión: Hay escasas estadísticas nacionales sobre TEH en relación a SHE. La edad, el riesgo cardiovascular y fenómenos epidemiológicos ofrecen posibles líneas investigativas. Más estudios son requeridos para dilucidar los factores que desencadenan sus complicaciones.

Introduction: The Hypertensive Syndrome of Pregnancy (SHE) is the set of pathological conditions derived from the increase in sustained blood pressure originating before and/or during the course of a pregnancy. Sometimes it requires hospital treatment. The objective of the study is to determine the rate of hospital discharge (TEH) due to complications of EHS during 2018-2021 in Chile. Materials and Methods: Descriptive transversal type of study about the complications of hypertensive pregnancy syndrome during the period from 2018 to 2021 according to age range and number of days in the hospital (n=12.006). Data obtained from the health statistics and information department, which did not require approval of the ethics committee. Results: PE had a higher TEH with 61.48 out of 100,000 people, affecting more women aged 20 to 44 years with 74.03 per 100,000 inhabitants. Complications of hypertensive pregnancy syndrome reported an average of 6.4 hospitalization days. The HELLP syndrome had more days with a quantity of 7.2. Discussion: Population aging, migration, and overweight-obesity might influence the increase in TEH/PE. Higher TEH of PE was reported in women aged 20 to 44 years, possibly due to cardiovascular factors, late maternity, and chronic hypertension. The HELLP syndrome implies a worse prognosis and reported more days at the hospital due to medical treatment. Conclusion: There are few national statistics on TEH in relation to SHE. Age, cardiovascular risk, and epidemiological phenomena offer possible lines of investigation. More studies are required to elucidate the factors that trigger its complications.

Adsorption of Organic Dyes on Magnetic Iron Oxide Nanoparticles. Part II: Field-Induced Nanoparticle Agglomeration and Magnetic Separation.

This paper (part II) is devoted to the effect of molecular adsorption on the surface of magnetic iron oxide nanoparticles (IONP) on the enhancement of their (secondary) field-induced agglomeration and magnetic separation. Experimentally, we use Methylene Blue (MB) cationic dye adsorption on citrate-coated maghemite nanoparticles to provoke primary agglomeration of IONP in the absence of the field. The secondary agglomeration is manifested through the appearance of needlelike micron-sized agglomerates in the presence of an applied magnetic field. With the increasing amount of adsorbed MB molecules, the size of the field-induced agglomerates increases and the magnetic separation on a magnetized micropillar becomes more efficient. These effects are mainly governed by the ratio of magnetic-to-thermal energy α, suspension supersaturation Δ0, and Brownian diffusivity Deff of primary agglomerates. The three parameters (α, Δ0, and Deff) are implicitly related to the surface coverage θ of IONP by MB molecules through the hydrodynamic size of primary agglomerates exponentially increasing with θ. Experiments and developed theoretical models allow quantitative evaluation of the θ effect on the efficiency of the secondary agglomeration and magnetic separation.

Bochdalek diaphragmatic hernia with bowel incarceration.

The purpose of this image is to illustrate a Bochdalek hernia diagnosis in a 39-year-old female patient treated on an emergency basis by means of CT-scan and following perioperative observation. Treatment consisted in initial laparoscopy that due to irreducible bowel incarceration was converted into hernia repair surgery through simple suture and thoracic drainage.

Impact of organ confined prostate cancer treatment on quality of life. / Impacto en la calidad de vida del tratamiento del cáncer de próstata organoconfinado.

INTRODUCTION: Prostate cancer (PCa) is the second most common male cancer in the world. Its incidence is estimated to grow to 1.7 million new cases and 499,000 new deaths by 2030. Treatment of OCPC can affect patients physically and mentally, as well as their close relationships and their job or career, which conditions health-related quality of life (QoL). OBJECTIVE: Evaluate the impact on QoL attributable to the treatment for Organ Confined Prostate Cancer (OCPC). MATERIALS AND METHODS: Prospective multicenter observational study of 406 patients with OCPC treated from January 2015 to June 2018. The sample was divided into four study groups, according to the type of treatment: radical prostatectomy (RP) (GA), external radiotherapy (ERT) (GB), brachytherapy (BT) (GC) and other treatments different from monotherapy with RP, ERT or BT (GD). RESULTS: The age in GC was lower, the mean Prostate Specific Antigen (PSA) of all patients was 8.13 ng/ml, the group with the highest mean PSA was GB with a mean of 10.43 ng/dL, the mean Tumor Stage (TNM) was 3.82, and GD had the lowest post treatment quality of life. CONCLUSION: OCPC treatment affects QoL. Curative monotherapies, specifically RP and BT, have less effect on QoL than external radiotherapy or other therapeutic alternatives. Urinary incontinence and fistulas secondary to OCPC have the highest impact on QOL impairment. The internationally validated SF 36 questionnaire is a useful cross-sectional measure of QOL to compare the impact of OCPC treatment modalities.

The influence of smoking on bacterial resistance after vaccine or antibiotic prophylaxis against recurrent urinary tract infections. / Influencia del tabaquismo en la resistencia bacteriana después de la profilaxis frente a infecciones urinarias recurrentes con antibiótico o con vacuna.

INTRODUCTION: The influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. MATERIAL AND METHODS: Retrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n=495); Subgroups: GA1 non-smoker (n=417), GA2 smoker (n=78). Group B (GB): Vaccine (n=360); Subgroups: GB1 non-smoker (n=263), GB2 smoker (n=97). VARIABLES: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. RESULTS: Mean age 56.51 years (18-75), similar between groups (P=.2257). No difference in the number of pretreatment UTIs (P=.1329) or in the distribution of the bacterial spectrum (P=.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (P=.0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (P=.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin/clavulanic acid). In GB2 E. coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (P=.0144). CONCLUSIONS: The development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.

Complications of transrectal prostate biopsy in our context. International multicenter study of 3350 patients. / Complicaciones de la biopsia transrectal de próstata en nuestro medio. Estudio multicéntrico internacional de 3.350 pacientes.

INTRODUCTION: Prostate cancer is the most common visceral neoplasm in men and the second one in the United States with the highest mortality behind lung cancer and ahead of colorectal cancer. While prostate cancer mortality rates have been reduced in the United States, Austria, United Kingdom and France, 5-year survival rates have been incremented in Sweden, probably due to a higher diagnostic activity and non-lethal tumor detection. TRPB usually has low rates of serious complications, with a not negligible number of minor complications. Mortality directly associated with this procedure is low and usually related to septic shock. The main complications derived from prostate biopsy can be infectious (mild or severe) and non-infectious (hematuria consistent with hemorrhage, urethral bleeding, rectal bleeding or hemospermia, acute urinary retention, pain or vasovagal reactions). MATERIAL AND METHOD: The objective of the study is to compare three usual TRPB protocols and their relationship with the incidence of complications. Retrospective multicenter observational study conducted in three countries (Spain, Italy and Portugal). We have reviewed the medical records of 3350 men who underwent TRPB to evaluate the existence of prostate cancer, with a minimum evolutionary control of 6months. RESULTS: The mean age was 65,50years, median 66, range 43-79. The subgroup analysis showed that younger patients had higher rates of acute urine retention (AUR) (P=.0000001). Likewise, our results revealed that younger patients presented more procedural pain (P=.0000001) than older patients. Regarding PSA, the mean value was 10.44, SD 7.73, median 8.15, range 0.98-68.09. A higher body mass index (BMI) was not associated with further infection (P=.000004). When performing the multivariate analysis, it was found that the significant variables in the general group were: age (P=.0013), PSA (P=.0402), local infiltration anesthesia (P=.0001) and prophylaxis with metronidazole +tobramycin +amoxicillin/clavulanic acid +gentamicin (P=.0001), presenting a normal distribution with high confidence interval (95%) and significant correlation. Prophylaxis is the most significant variable for no complications and pain (P=.0001), age (P=.0013) and prophylaxis (P=.0001) are for bleeding, age (P=.0013), prophylaxis and PSA (P=.0001) are for infection, and finally, age (P=.0013), anesthesia with local infiltration and prophylaxis (P=.0001) and PSA (P=.0402) are for AUR. CONCLUSIONS: Sedation has fewer side effects and complications related to the transrectal prostate biopsy procedure with respect to transrectal local anesthesia. The choice of the antibiotic prophylaxis scheme is decisive in the onset of complications arising from the performance of a transrectal prostate biopsy.

[Myasthenia gravis associated with nivolumab]. / Miastenia grave asociada a nivolumab.

TITLE: Miastenia grave asociada a nivolumab.

Poliposis adenomatosa familiar y prevención del cáncer colorrectal: reporte de un caso / Familial adenomatous polyposis and colorectal cancer prevention: A case report

Resumen La poliposis adenomatosa familiar (PAF) es una enfermedad hereditaria caracterizada por el crecimiento de múltiples adenomas epiteliales de distribución colorrectal, de patrón autosómico dominante causado por el defecto del gen APC. La degeneración de cáncer colorrectal en estos pacientes se considera inevitable en caso de no recibir el manejo terapéutico adecuado. Se presenta el caso de una paciente femenina de 25 años, quien acudió a consulta luego de presentar una modificación del patrón evacuatorio y dolor abdominal, sin antecedentes familiares asociados, por lo que se correlacionó con paraclínicos y se diagnosticó PAF, con la posterior implementación del manejo terapéutico. Se decidió hacer una revisión bibliográfica y actualización del tema resaltando los aspectos clínicos de reconocimiento de la enfermedad, así como las conductas a tomar en consideración para la prevención del cáncer en pacientes con PAF.

Abstract Familial adenomatous polyposis (FAP) is a hereditary disease characterized by the growth of multiple colorectal epithelial adenomas. It is an autosomal dominant disorder caused by an APC gene defect. Degeneration to colorectal cancer is considered unavoidable in these patients if they do not receive adequate therapeutic management. We present the case of a 25-year-old female patient consulted after a change in her evacuation pattern and abdominal pain. She had no relevant family history associated but based on results of paraclinical tests diagnosis of FAP was made for which therapeutic management was implemented. This is a case report with a literature review and update of the topic highlighting clinical issues related to recognition of the disease and issues that should be taken into consideration for the prevention of cancer in patients with FAP.

Prevalence of oral side effects of chemotherapy and its relationship with periodontal risk: a cross sectional study.

PURPOSE: To determine the prevalence of professionally reported oral side effects of chemotherapy and the self-reported oral side effects and whether both prevalences could be related to the periodontal risk of the patients. METHODS: A cross-sectional study with patients undergoing chemotherapy treatment was carried out. Demographic, oral hygiene habits, and cancer-related data were collected while the patient was receiving the chemotherapy infusion. Patient's oral status, measured according to the oral-assessment guide for patients in hospital environments, patient-related outcomes (PROMs), measured by a visual analogue scale, and patient's periodontal risk were analyzed using validated questionnaires. Data was reported in means and standard deviations (SD) in quantitative variables and in counts, prevalence, and 95% confidence intervals (CI) in qualitative variables. ANOVA test and chi-squared tests were used to compare oral side effects among different periodontal risk groups. RESULTS: Three hundred sixty-nine patients were included in the study. The prevalence of professionally reported oral side effects was 86.99% (95% confidence interval CI 83.54%; 90.44%). The prevalence of self-reported oral side effects was 89.70% (95% CI 86.59; 92.82). The most common oral side effects were xerostomia (73.4%), dysgeusia (61.8%), and dry lips (54.2%). More oral alterations were found in patients with worse periodontal risk (p < 0.001). CONCLUSIONS: The prevalence of oral side effects (professional or self-reported) is higher than 85% in patients undergoing chemotherapy. This prevalence increases as the risk of developing periodontal disease does.

A robust and versatile mass spectrometry platform for comprehensive assessment of the thiol redox metabolome.

Several diseases are associated with perturbations in redox signaling and aberrant hydrogen sulfide metabolism, and numerous analytical methods exist for the measurement of the sulfur-containing species affected. However, uncertainty remains about their concentrations and speciation in cells/biofluids, perhaps in part due to differences in sample processing and detection principles. Using ultrahigh-performance liquid chromatography in combination with electrospray-ionization tandem mass spectrometry we here outline a specific and sensitive platform for the simultaneous measurement of 12 analytes, including total and free thiols, their disulfides and sulfide in complex biological matrices such as blood, saliva and urine. Total assay run time is < 10 min, enabling high-throughput analysis. Enhanced sensitivity and avoidance of artifactual thiol oxidation is achieved by taking advantage of the rapid reaction of sulfhydryl groups with N-ethylmaleimide. We optimized the analytical procedure for detection and separation conditions, linearity and precision including three stable isotope labelled standards. Its versatility for future more comprehensive coverage of the thiol redox metabolome was demonstrated by implementing additional analytes such as methanethiol, N-acetylcysteine, and coenzyme A. Apparent plasma sulfide concentrations were found to vary substantially with sample pretreatment and nature of the alkylating agent. In addition to protein binding in the form of mixed disulfides (S-thiolation) a significant fraction of aminothiols and sulfide appears to be also non-covalently associated with proteins. Methodological accuracy was tested by comparing the plasma redox status of 10 healthy human volunteers to a well-established protocol optimized for reduced/oxidized glutathione. In a proof-of-principle study a deeper analysis of the thiol redox metabolome including free reduced/oxidized as well as bound thiols and sulfide was performed. Additional determination of acid-labile sulfide/thiols was demonstrated in human blood cells, urine and saliva. Using this simplified mass spectrometry-based workflow the thiol redox metabolome can be determined in samples from clinical and translational studies, providing a novel prognostic/diagnostic platform for patient stratification, drug monitoring, and identification of new therapeutic approaches in redox diseases.

Hyperthermia-Triggered Gemcitabine Release from Polymer-Coated Magnetite Nanoparticles.

In this work a combined, multifunctional platform, which was devised for the simultaneous application of magnetic hyperthermia and the delivery of the antitumor drug gemcitabine, is described and tested in vitro. The system consists of magnetite particles embedded in a polymer envelope, designed to make them biocompatible, thanks to the presence of poly (ethylene glycol) in the polymer shell. The commercial particles, after thorough cleaning, are provided with carboxyl terminal groups, so that at physiological pH they present negative surface charge. This was proved by electrophoresis, and makes it possible to electrostatically adsorb gemcitabine hydrochloride, which is the active drug of the resulting nanostructure. Both electrophoresis and infrared spectroscopy are used to confirm the adsorption of the drug. The gemcitabine-loaded particles are tested regarding their ability to release it while heating the surroundings by magnetic hyperthermia, in principle their chances as antitumor agents. The release, with first-order kinetics, is found to be faster when carried out in a thermostated bath at 43 °C than at 37 °C, as expected. But, the main result of this investigation is that while the particles retain their hyperthermia response, with reasonably high heating power, they release the drug faster and with zeroth-order kinetics when they are maintained at 43 °C under the action of the alternating magnetic field used for hyperthermia.

Simplified technique for passing the wire in a single time for the treatment of multifragmentary patella fractures.

OBJECTIVE: To compare the efficacy and safety of prescription pattern in treatment of multifragmentary patellar fractures in a trauma reference center. MATERIAL AND METHODS: We conducted a cross-sectional study of patients record with multifragmentary patellar fractures from December 2010 to December 2013, comparing treatments that include tension band wire, simple cerclage, double cerclage to bone-tendon junction and conservative treatment. RESULTS: With a total of 92 patients, including 60 women (65.21%) and 32 men (34.78%), with an average age of 61 years. In the double cerclage, surgery time was shorter (average 38 minutes), and the range of motion showed improvement since the first month. Minor complications were observed in patients treated conservatively (arthrofibrosis). CONCLUSIONS: At our institution, the most efficient method was the double cerclage to the bone-tendon junction presenting shorter duration of surgery, less ischemic time and faster recovery with range of motion close to normal since the first month after surgery (p = 0.000). The safest method of treatment was conservative treatment, with fewer cases with complications (p = 0.184).

OBJETIVO: Comparar la eficacia y seguridad del patrón de prescripción en el tratamiento de las fracturas patelares multifragmentarias en un centro de referencia de trauma. MATERIAL Y MÉTODOS: Realizamos un estudio seccionado transversalmente de expedientes de pacientes con fracturas patelares multifragmentarias de Diciembre del 2010 a Diciembre del 2013, comparando los tratamientos que incluyen obenque, cerclaje simple, cerclaje doble y tratamiento no quirúrgico. RESULTADOS: Se analizaron 92 pacientes, incluyendo 60 mujeres (65.21%) y 32 hombres (34.78%), con edad promedio de 61 años. En el cerclaje doble, el tiempo de la cirugía fue más corto (promedio 38 minutos), y la gama del movimiento demostró mejora desde el primer mes. Las complicaciones de menor importancia fueron observadas en los pacientes tratados no quirúrgicamente (artrofibrosis). CONCLUSIONES: En nuestra institución, el método más eficiente fue el cerclaje doble a la unión hueso-tendón que presenta una duración más corta de la cirugía, menos tiempo de isquemia y recuperación más rápida con la gama del movimiento cerca de lo normal desde el primer mes después de la cirugía (p = 0.000). El método de tratamiento más seguro fue el tratamiento conservador, con menos casos con complicaciones (p = 0.184).

Chondroma of the Bladder: An Atypical Localization.

Chondroma is a benign tumour of mesenchymal origin that is composed of cartilage and rarely located in soft tissues, being described so far only in four cases, as located in the bladder, according to our knowledge. We describe the fifth case of a 67-year-old woman who consulted for microscopic haematuria, with an endoscopic finding of submucosal nodular image in the anterior wall of the bladder, which after resection and the histologic study shows cartilage and fibroconnective tissue, in part hyalinised, and positive immunohistochemical staining of cells with vimentin and S-100; this fact can support the diagnosis of bladder chondroma.

[Pleural cavity concerns]. / Los quebraderos de cabeza del espacio pleural.

INTRODUCTION: Persistent air leak (PAL) is a common problem. We asses our experience in the management of these patients. MATERIAL AND METHODS: Retrospective review of patients with chest tubes after bronchopulmonary pneumothorax (due to lung resections, spontaneous pneumothorax, necrotizing pneumonia) from 2010 to 2015. We studied clinical data, PAL incidence, risk factors and treatment, considering PAL ≥ 5 days. RESULTS: Thirty-seven cases (28 patients) between 0-16years: 26 lung resections, 11 pneumothorax. We found no differences in the distribution of age, weight, indication or comorbidity, but we noticed a trend to shorter hospital stay in infants. Patients with staple-line reinforcement presented lower PAL incidence than patients with no mechanical suture (43% vs 37%), the difference is even apparent when applying tissue sealants (29% vs 50%) (p > 0.05). We encountered no relationship between the size of the tube (10-24 Fr) or the type of resection, with bigger air leaks the higher suction pressure. We performed 13 pleurodesis in 7 patients (2 lobectomies, 3 segmentectomies and 2 bronchopleural fistulas), with 70% effectiveness. We conducted 7 procedures with autologous blood (1.6 ml/kg), 2 with povidone-iodine (0.5 ml/kg), 2 mechanical thoracoscopic and 2 open ones. We repeated pleurodesis four times, 3 of them after autologous blood infusion: 2 infusions with the same dose (both effective) and the other 2 as thoracotomy in patients with bronchopleural fistulas. After instillation of blood 3 patients presented with fever. After povidone-iodine instillation, the patient suffered from fever and rash. CONCLUSIONS: Intraoperative technical aspects are essential to reduce the risk of PAL. Autologous blood pleurodesis, single or repeated, is a minimal invasive option, very safe and effective to treat the parenchymatous PAL.

INTRODUCCION: La fuga aérea persistente (FAP) es un problema común. Evaluamos nuestra experiencia en el manejo de estos pacientes. MATERIAL Y METODOS: Revisión retrospectiva 2010-2015 de pacientes con drenaje endotorácico por neumotórax broncopulmonar (resecciones pulmonares, neumotórax, neumonía necrotizante). Revisamos datos clínicos, incidencia de FAP, factores determinantes y tratamiento, considerando FAP ≥ 5 días. RESULTADOS: Treinta y siete casos (28 pacientes) con edades entre 0-16 años: 26 resecciones pulmonares, 11 neumotórax. No encontramos diferencias en distribución de edad, peso, indicación quirúrgica ni comorbilidad, aunque sí tendencia a menor estancia hospitalaria en lactantes. Los pacientes con sutura no mecánica presentaron más fugas que los pacientes con sutura mecánica (43 vs 37%), así como los pacientes a los que no se aplicaron sellantes tisulares (29 vs 50%) (ambos p > 0,05). No encontramos relación con el tamaño del tubo (10-24 Fr) ni con el tipo de resección, manteniendo más fuga aérea los de mayor presión de aspiración. Realizamos 13 pleurodesis en 7 pacientes (2 lobectomías, 3 segmentectomías y 2 fístulas broncopleurales), con efectividad del 70%. Realizamos 7 con sangre autóloga (1,6 ml/kg), 2 con povidona iodada (0,5 ml/kg), 2 mecánicas toracoscópicas y 2 abiertas. Se repitió la pleurodesis en 4 ocasiones, 3 de ellas tras sangre autóloga: dos con repetición de la misma dosis (ambas efectivas) y otras dos por toracotomía en los pacientes con fístula broncopleural. Tras la instilación de sangre 3 casos presentaron fiebre. Tras la de povidona iodada, fiebre y exantema. CONCLUSIONES: Los aspectos técnicos intraoperatorios son esenciales para disminuir el riesgo de FAP. La pleurodesis con sangre autóloga, única o repetida, es una opción poco invasiva, muy segura y efectiva para las FAP parenquimatosas en nuestra muestra.

[Prescription pattern in the management of Type I open forearm fractures in pediatric patients]. / Patrón de prescripción en el manejo de las fracturas expuestas tipo I de antebrazo en pediatría.

BACKGROUND: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy. MATERIAL AND METHODS: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013. RESULTS: Ninety-two patients with a diagnosis of Type I open forearm fracture were included. All patients received parenteral antibiotics and underwent surgical debridement. However, in 69 (75%) of them a cast was used; in 9 (10%) a splint was used; 9 (10%) underwent fixation with Kirschner nails, and 5 (5.4%) underwent open reduction and internal fixation (ORIF). Eight patients (9%) required reoperation. CONCLUSIONS: Surgical management is the predominant prescription pattern in pediatric patients with Type I open forearm fracture. The latter is the predominant eepidemiology. The type of management was associated with a second surgery (p 0.000); however, this did not have a statistically significant impact on the hospital stay (p = 0.09).

ANTECEDENTES: Las fracturas expuestas en niños comprenden más de 10% de los ingresos hospitalarios a un departamento clínico de traumatología pediátrica. Resulta importante identificar el patrón de prescripción de manejo quirúrgico predominante en pacientes pediátricos atendidos en un centro de referencia de una economía emergente con fractura expuesta tipo I de antebrazo. MATERIAL Y MÉTODOS: Estudio por muestreo de casos consecutivos, observacional, transversal, analítico y de fuentes secundarias (bitácora). Fueron considerados todos los casos de sujetos menores de 17 años con fracturas expuestas tipo I de antebrazo, hospitalizados en un departamento clínico de traumatología pediátrica del 1o de Enero de 2009 al 31 de Diciembre de 2013. RESULTADOS: Noventa y dos personas con diagnóstico de fractura expuesta tipo I de antebrazo fueron incluidas. A todas se les realizó administración de antibiótico parenteral, así como desbridamiento quirúrgico; sin embargo, a 69 también se les colocó aparato de yeso (75%), a nueve se les puso férula (10%), a nueve se les realizó fijación con clavillos Kirschner (10%) y a cinco se les realizó reducción abierta y fijación interna (RAFI), (5.4%). Ocho niños (9%) requirieron una reintervención. CONCLUSIONES: Predomina el patrón de prescripción de manejo quirúrgico en pacientes pediátricos con fractura expuesta tipo I de antebrazo, así como su epidemiología. El tipo de manejo estuvo asociado con una segunda cirugía (p 0.000); sin embargo, esto no tuvo impacto estadísticamente significativo en la estancia hospitalaria (p = 0.09).

Experimental murine model of renal cancer. / Modelo murino experimental de cáncer renal.

INTRODUCTION: The objective of this study was to determine the reproducibility in a murine model of renal tumours of various histological strains that could be useful for investigating the response to target drugs. MATERIAL AND METHODS: Development and analysis of the "in vivo" model: tumour xenograft of renal cell carcinomas with Balb/c nude athymic mice. Nontumourous human renal tissue was implanted in the interscapular region of 5 mice, chromophobe renal cell carcinoma was implanted in 5 mice (which, after checking its growth, was prepared for implantation in another 10 mice) and Fuhrman grade 2 clear cell renal cell carcinoma (CCRCC) was implanted in 5 mice (which was also subsequently implanted in 10 mice). We monitored the tumour size, onset of metastases and increase in size and number of tumours. When the size had reached a point greater than or equal to locally advanced or metastatic carcinoma, the animals were euthanised for a pathological and immunohistochemical study and a second phase of implantation. RESULTS: The subcutaneous xenograft of the healthy tissue did not grow. The animals were euthanised at 6 months and no renal tissue was found. The chromophobe renal cell carcinoma cells grew in the initial phase (100%); however, in the second phase, we observed a chronic lymphomonocyte inflammatory reaction and a foreign body reaction. The CCRCC grew at 5-8 months both in the first and second phase (100%), maintaining the tumour type and grade. CONCLUSIONS: The model with athymic Balb/c nude mice is useful for reproducing CCRCC, with the same histological characteristics and aggressiveness as native human tumours, promoting the development of the second experimental phase.