[Gastric bypass in the surgical treatment of the morbid obesity and super obesity: comparative study]. / Bypass gástrico en el tratamiento de la obesidad mórbida y la superobesidad: estudio comparativo.

INTRODUCTION: Gastric Bypass (GB) constitutes the surgical treatment of election of morbid obesity (BMI < 50) at the present time, however doubts exist about its effectiveness in super obesity patients (BMI > 50). OBJECTIVE: The purpose of this work is one of to analyze the results of loss of weight of the first 52 open GB of our series, and to compare the losses of weight in morbid obesity (MO) and super obesity (SO), to determine if the superobese patient looses enough weight with this technique or if it would be more indicated another technique more malabsorptive, like some authors recommend. MATERIALS AND METHOD: Retrospective study of the first 52 patients operated of open GB pathway. The weight loss of 32 patients' with MO are compared with the weight loss of 20 patients with super obesity after five year follow-up. The parameters analyzed are: age, sex, height, initial weight, current weight, initial BMI, current BMI, % BMI lost, % overweight lost, incidence of incisional hernia, acceptable oral tolerance and metabolic alterations. The malabsorptive procedure associated in patients with super obesity was a 200 cm Roux-en-Y and a patients with BMI between 40 and 50 was a 150 cm Roux-en-Y. The results are compared by means of the X2 and Mann Whitney statistical test. RESULTS: The age, the sex and the stature are homogeneous in the two groups. In the group of MO the initial weight was of 121.5 kg; initial BMI, 45; current BMI; 28.9, the median loss of weight in 5 years was of 48 kg; the percentage loss of the excess of BMI is of 80% and the percentage loss of the excess of weight is of 74.6%. In the group of SO the initial weight was of 142.,7 kg; initial BMI, 54.9; current BMI, 34.,9; the median loss of weight in 5 years was of 54 kg; the percentage loss of the excess of BMI was of 65,3% and the percentage loss of the excess of weight was of 63.2%. The analysis of the results ponders shows that it exists statistically significant differences (P < 0.05) among the two groups, however the rate of success, according to the classic parameter of loss of more than 50% of the excess of weight, was superior to 90% in both groups. The results of the study about the presence of incisional postoperative hernia, alimentary tolerance and metabolic alterations, indicate that it doesn't exist differences statistically significant between both groups. CONCLUSIONS: GB is an effective surgical technique in patients with morbid obesity and with super obesity, provided that in these patients is realized a procedure more malabsorptive. There are not differences between both groups, in morbidity, improvement in the associate disease, alimentary tolerance and necessity of nutritional supplements.

Colovesical fistula complicating diverticular disease: one-stage resection.

Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.

La hernia umbilical en régimen de cirugía mayor ambulatoria: procedimiento seguro y de menor coste / Umbilical hernia in major outpatient surgery: safe and lower-cost procedure

Introducción: La cirugía mayor ambulatoria (CMA) constituye una estrategia coste-efectiva comparada con la cirugía tradicional, al resolver el procedimiento quirúrgico sin comprometer la calidad de la atención ni la seguridad del paciente. Objetivo: Demostrar que la cirugía abierta de la hernia umbilical en régimen de CMA es un procedimiento seguro y de menor coste. Para ello realizamos un estudio de los factores de riesgo de ingreso no previsto en pacientes intervenidos de hernia umbilical en nuestro servicio, durante cuatro años. Material y métodos: Estudio observacional retrospectivo de 478 pacientes consecutivos intervenidos durante los años 2015 a 2018. Se revisaron las historias electrónicas de los pacientes y se creó una base de datos para el estudio de los resultados. Se utilizó un modelo de regresión logística para analizar el factor de riesgo de ingreso no previsto por edad, sexo, antecedentes personales, índice de masa corporal, ASA del paciente, tipo de reparación, tamaño del defecto, utilización de prótesis, causa del ingreso no previsto y complicaciones. Resultados: Edad media 48,1 ± 13 años con un índice de hospitalización global del 8,8 %. Hombres 319 (66,7 %) y mujeres 159 (33,3 %) con una tasa de ingresos no previstos del 6,9 % y 12,6 %, respectivamente ( p = 0,039). El análisis estadístico demostró que no se incrementa el riesgo de ingreso no previsto con la edad (0,678). El riesgo de hospitalización fue 2,78 veces mayor en las mujeres que en los hombres ( p = 0,005). Los pacientes ASA II tienen un riesgo de hospitalización 6,49 veces superior a los pacientes con ASA I (0,021) (AU)

Introducción: La cirugía mayor ambulatoria (CMA) constituye una estrategia coste-efectiva comparada con la cirugía tradicional, al resolver el procedimiento quirúrgico sin comprometer la calidad de la atención ni la seguridad del paciente. Objetivo: Demostrar que la cirugía abierta de la hernia umbilical en régimen de CMA es un procedimiento seguro y de menor coste.To this end, we conducted a study of the risk factors for unforeseen admission in patients operated on for umbilical hernia in our service, for four years. Material and methods: Retrospective observational study of 478 consecutive patients operated on during the years 2015 to 2018. Electronic patient records were reviewed and a database was created for the study of outcomes. A logistic regression model was used to analyze the risk factor for unplanned admission by age, sex, personal history, body mass index, patient ASA, type of repair, defect size, use of prostheses, cause of unplanned admission and complications. Results: Mean age 48.1 ± 13 years with an overall hospitalization rate of 8.8 %. Males 319 (66.7%) and females 159 (33.3%) with an unforeseen income rate of 6.9% and 12.6%, respectively (p = 0.039). Statistical analysis showed that the risk of unplanned admission does not increase with age (0.678) The risk of hospitalization was 2.78 times higher in women than in men (p = 0.005). ASA II patients have a 6.49-fold higher risk of hospitalization than patients with ASA I (0.021). A greater number of admissions was found in patients operated on with general anesthesia and spinal anesthesia, compared to those operated with local anesthesia and sedation or with a laryngeal mask (p = 0.000). Major outpatient surgery was cheaper than surgery with admission, between 45-52%, with a statistically significant difference (p = 0.000) (AU)

Cirugía bariátrica como tratamiento de la diabetes tipo 2. Revisión de la literatura / Bariatric surgery as a treatment for type 2 diabetes. Literature review

INTRODUCCIÓN: La obesidad y la diabetes tipo 2 son dos patologías crónicas de características fisiopatológicas complejas y estrechamente relacionadas entre sí. En el campo metabólico de la diabetes, el empleo de la cirugía bariátrica se ha posicionado como una de las herramientas terapéuticas útiles respecto al manejo y control de esta patología. OBJETIVO: Presentar los resultados de una revisión de la literatura disponible sobre la aplicación y utilidad de la cirugía bariátrica como tratamiento efectivo de la diabetes mellitus tipo 2 asociada a obesidad. MATERIALES Y MÉTODOS: Se ha realizado una búsqueda bibliográfica a través de las bases de datos PubMed y Web Of Science, ajustada al periodo de tiempo comprendido entre los años 2008 - 2020 (doce años). Los descriptores y palabras claves empleadas para la búsqueda fueron "Diabetes Mellitus Type 2", "Bariatric Surgery" y "Thera-peutics". Se incluyeron un total de 38 artículos. Se realizó la selección de publicaciones en base a revisiones sistemáticas, ensayos clínicos y metaanálisis. La selección y lectura fue realizada atendiendo a criterios de relevancia (algoritmo Best Match en PubMed y algoritmo de relevancia en Web Of Science). RESULTADOS: Se han publicado una importante cantidad de estudios en los que se incluyen pacientes con diabetes y obesidad y los resultados tras la cirugía metabólica. Entre estos trabajos destaca el meta-análisis de Panunzi et al., el más amplio publicado hasta la fecha, que cuenta con más de 94.579 pacientes sometidos a cirugía bariátrica/metabólica y muestra una remisión completa de la diabetes tras la cirugía. No obstante, debe tenerse en cuenta la corta duración del seguimiento de 2-3 años. Otros ensayos aleatorizados realizados en pacientes con obesidad y diabetes sometidos a cirugía bariátrica, con seguimiento a medio plazo (3-5 años), han obtenido resultados positivos comparables. Respecto a estudios a largo plazo (con periodos de seguimiento > 8-10 años), no existen demasiadas publicaciones, siendo este, uno de los objetivos pendientes de la investigación en el campo de la cirugía bariátrica. CONCLUSIÓN: Aunque se requieren más estudios a largo plazo, es patente, la existencia de una alta evidencia científica que respalda el beneficio de la cirugía bariátrica a corto y medio plazo en pacientes seleccionados con obesidad y diabetes mellitus tipo 2 mal controlada

INTRODUCTION: Obesity and type 2 diabetes are two chronic pathologies with complex pathophysiological characteristics and closely related to each other. In the metabolic field of diabetes, the use of bariatric surgery has become one of the useful therapeutic tools regarding the management and control of this pathology. OBJECTIVE: To present the results of a review of the available literature on the application and utility of bariatric surgery as an effective treatment for type 2 diabetes mellitus associated with obesity. MATERIALS AND METHODS: A bibliographic search was carried out through the PubMed and Web of Science databases, adjusted for the period of time between the years 2008 - 2020 (twelve years). The descriptors and keywords used for the search were "Diabetes Mellitus Type 2", "Bariatric Surgery" and "Therapeutics". A total of 38 articles were included. Selection of publications was made based on systematic reviews, clinical trials, and meta-analyzes. The selection and reading was carried out according to relevance criteria (Best Match algorithm in PubMed and relevance algorithm in Web of Science). RESULTS: A significant number of studies have been published including patients with diabetes and obesity and the results after metabolic surgery. Among these works, the meta-analysis of Panunzi et al.,the most extensive published to date, stands out, which has 94,579 patients undergoing bariatric / metabolic surgery and shows a complete remission of diabetes after surgery. However, the short duration of follow-up of 2-3 years should be taken into account. Other randomized trials conducted in patients with obesity and diabetes undergoing bariatric surgery, with medium-term follow-up (3-5 years), have obtained comparable positive results. Regarding long-term studies (with follow-up periods> 8-10 years), there are not too many publications, this being one of the pending objectives of the research in the field of bariatric surgery. CONCLUSION: Although more long-term studies are required, the existence of high scientific evidence that supports the benefit of bariatric surgery in the short and medium term in selected patients with obesity and poorly controlled type 2 diabetes mellitus is clear

Factores predictivos de recurrencia tras la reparación abierta de la hernia umbilical en 551 pacientes consecutivos. Estudio observacional retrospectivo / Predictors for recurrence after open um-bilical hernia repair in 551 consecutive patients. Observactional retrospective study

INTRODUCCIÓN: La recurrencia tras la reparación abierta de la hernia umbilical, constituye un problema importante para el paciente, el sistema sanitario y para el equipo quirúrgico. Actualmente, no existe consenso entre las sociedades quirúrgicas sobre los factores de riesgo de recidiva. Determinar estos factores es fundamental para corregirlos, realizar el tratamiento más apropiado y disminuir la tasa de la misma. OBJETIVO: El propósito de este estudio es evaluar los factores predictivos de recidiva tras la reparación abierta de la hernia umbilical con y sin malla, en cado uno de los periodos del proceso quirúrgico (preoperatorio, intraoperatorio y postoperatorio), en los pacientes operados en nuestro servicio durante 4 años. Material y MÉTODOS: Estudio observacional retrospectivo de 551 pacientes consecutivos intervenidos durante los años 2015 a 2018. Se revisaron las historias electrónicas de los pacientes y se creó una base de datos para el estudio de los resultados. El modelo de la regresión de Cox univariable y multivariable se utilizó para analizar la supervivencia libre de recurrencia por edad, sexo, índice de masa corporal, ASA del paciente, tabaquismo, diabetes, broncopatía, tamaño del defecto, tipo de reparación, clase de prótesis y complicaciones. Las curvas de Kaplan-Meier se utilizaron para analizar la supervivencia libre de recurrencia para factores de riesgo preoperatorios, intraoperatorios y postoperatorios. RESULTADOS: Edad media de los pacientes, 49,9 ± 13,9 años con una tasa de recurrencia global del 6,5%. Hombres 367 (66,6%) y recidiva del 5,7%. Mujeres 184 (33,4%) y recaída del 8,2% (P = 0,276). Seguimiento medio de 14,6 (± 12,3) meses. La mayoría de los pacientes (96,4%), se clasificaron de bajo riesgo anestésico (ASA I y II), con una recurrencia del 6,3% y 20 pacientes ASA III (3,6%) con recidiva del 10% (P = 0,564). Respecto al peso, 124 pacientes (22,5%) tenían un IMC < 25 con una tasa de recidiva del 5,6%, 215 pacientes (39%) con IMC >25-30 con una recurrencia del 6,5% y 212 pacientes (38,5%) con IMC >30 (38,5%) y recidiva del 7,5%. Se contabilizaron 61 pacientes (11,1%) diabéticos con 4 recidivas (6,6%) (p = 0,994). Broncopatía en 64 pacientes (11,6%) con una recurrencia del 10,9% (p = 0,129). Tabaquismo en 132 pacientes (24,5%) con recurrencia del 6,3% y 74 herniorráfias (13,4%) con una recidiva del 8,1%. Hernioplástia con malla simple en 424 casos con una recurrencia del 6,6% y hernioplástia con malla compuesta en 53 casos con una recidiva del 3,8% (P=0,617). Tamaño medio del defecto 2,75 cm (0,5-4 cm). Complicaciones postoperatorias: seroma en 22 casos (4%) y tasa recidiva 22,7% (P=0,002), infección quirúrgica en 18 casos con recurrencia del22,2% (P = 0,006). El análisis estadístico demuestra que por cada año de edad, el riesgo de recurrencia aumenta un 3% (P = 0.068), que las mujeres tienen un 52% más riesgo de recidiva que los hombres (P = 0,277), que la obesidad presenta un 46% más riesgo de recaída (p = 0,313) y que la broncopatía tiene 3 veces más riesgo de recidiva (P = 0,030). La infección quirúrgica representa un 75% más riesgo de recurrencia (p = 0,608) y el seroma representa un riesgo 5 veces mayor de recurrencia, estadísticamente significativa (p = 0,004). CONCLUSIÓN: Nuestros resultados indican que a mayor edad, el sexo femenino, ASA III, alto índice de masa corporal, diabetes, broncopatía, tamaño del defecto herniario, tipo de reparación, infección quirúrgica y seroma fueron los factores asociados con un mayor riesgo de recurrencia después de la reparación abierta de la hernia umbilical

INTRODUCTION: Recurrence after open umbilical hernia repair constitutes an important problem for the patient, the health system and the surgical team. Currently, there is no consensus among surgical societies on the risk factors for hernia recurrence. Determining these factors is essential to correct them, carry out the most appropriate treatment and reduce the recurrence rate. OBJECTIVE: The purpose of this study is to evaluate the predictive factors of recurrence after open repair of umbilical hernia with and without mesh, in each of the periods of the surgical process (preoperative, intraoperative and postoperative), in patients operated on in our service for 4 years. MATERIAL AND METHODS: Retrospective observational study of 551 consecutive patients operated during the years 2015 to 2018. The electronic records of the patients were reviewed and a database was created to study the results. Univariate and multivariate Cox regression was used to analyze recurrence-free survival by age, sex, body mass index, ASA of the patient, smoking, diabetes, bronchopathy, size of the defect, type of repair, class of prosthesis, and complications. Kaplan-Meier curves were used to analyze recurrence-free survival for preoperative, intraoperative, and postoperative risk factors. RESULTS: Mean age of the patients, 49.9 ± 13.9 years. Men 367 (66.6%) and women 184 (33.4%) (P = 0.693). Global recurrence rate 6.5%. Recurrence in women, 8.2%. Recurrence in men 5.7% (P = 0.276). Mean follow-up of 14.6 (± 12.3) months. Most of the patients were classified as low anesthetic risk (ASA I and II), 531 patients (96.4%) with a recurrence of 6.3% and 20 ASA III patients (3.6%) with a recurrence of the 10% (P = 0.564). Regarding weight, 124 patients (22.5%) had a normal weight with a relapse of 5.6%, 215 patients (39%) were overweight with a relapse of 6.5% and 212 were obese (38.5% ) with a recurrence rate of 7.5%. There were 61 diabetic patients (11.1%) with 4 relapses (6.6%) (p = 0.994). Bronchopathy in 64 patients (11.6%) with a recurrence of 10.9% (p = 0.129). Smoking in 132 patients (24.5%) with a recurrence of 6.1% (P = 0.801). Regarding the technical aspects, 477 hernioplasties (86.6%) were performed with a recurrence rate of 6.3% and 74 herniorrhaphies (13.4%) with a recurrence of 8.1%. Simple mesh hernioplasty in 424 cases with a recurrence of 6.6% and hernioplasty with composite mesh in 53 cases with a recurrence of 3.8% (P = 0.617). Ave-rage default size 2.75 cm (0.5-4 cm). Postoperative complications: 22 patients (4%) presented seroma with a recurrence of 22.7% (P = 0.002) and 18 patients (3.3%) presented surgical infection with a recurrence rate of 22.2% (P = 0.006 ). After statistical analysis and when adjusting the selected variables, it was detected: that for each year of age, the risk of recurrence increases by 3% (P = 0.068), that women have a 52% higher risk of recurrence than men (P = 0.277), that obesity has a 46% higher risk of relapse (p = 0.313) and that bronchopathy has a 3 times higher risk of recurrence (P = 0.030). Surgical infection represents a 75% higher risk of recurrence (p = 0.608) and postoperative seroma represents a statistically significant 5 times higher risk of recurrence (p = 0.004). CONCLUSION: Our results indicate that at older age, female sex, ASA III, high body mass index, diabetes, bronchopathy, size of the hernial defect, type of repair, surgical infection and seroma were the factors associated with a higher risk of recurrence. after open umbilical hernia repair

Mucocele apendicular como hallazgo casual en prueba de imagen / Appendicular mucocele as an incidental finding on imaging test

El mucocele apendicular (MA) es una entidad poco frecuente. Su incidencia sitúa entre el 0,2 y 0,4% de todas las apendicectomías y del 8 al 10% de todos los tumores apendiculares. El término mucocele consiste en la dilatación del apéndice causada por la producción moco, secundario a un proceso benigno o maligno (cistoadenoma o cistoadenocarcinoma). Presentamos el caso de una paciente de 63 años de edad asintomática y que en el estudio por sospecha de hidronefrosis izquierda se encontró como hallazgo en la ecografía de abdomen, una imagen sugerente de mucocele apendicular que se constató en la tomo-grafía computarizada (TC). Se realizó una apendicectomía laparoscópica. El estudio histológico mostró un mucocele apendicular con bordes libres y sin signos de malignidad. Un año después de la intervención la paciente está libre de enfermedad y de otro proceso asociado. El propósito del presente estudio es el de realizar una revisión relacionada con la incidencia, manifestaciones clínicas, métodos diagnósticos, tratamiento, evolución, diagnóstico diferencial y anatomopatológico

Appendicular mucocele (AM) is a rare entity. Its frequency is estimated between 0.2 and 0.4% of all appendectomies and 8 to 10% of all appendicular tumors. The term mucocele refers to the dilation of the appendix by mucus, caused by a benign or malignant process (cystadenoma or cystadenocarcinoma).We present the case of an asymptomatic 63-year-old patient who, in the study of suspected left hydronephrosis, found an image suggestive of appendicular mucocele as a finding on abdominal ultrasound, which was confirmed by computed tomography (CT). A laparoscopic appendectomy was performed. The histological study showed an appendicular mucocele without malignancy and free edges. One year after the intervention, the patient is free of disease and of another synchronous or metachronous process. The purpose of the present study is to carry out a review regarding the incidence, clinical manifestations, diagnostic methods, treatment, evolution and pathological diagnosis

[Mediastinal bronchogenic cyst in the carina of an asymptomatic patient]. / Quiste broncogénico mediastínico en carina de paciente asintomático.

A patient of 30 year-old male with a bronchogenic cyst in the mediastinum detected as an incidental finding on a routine chest X-ray is presented. Laboratory examinations did not reveal any significant abnormalities. Chest X-ray and TAC revealed the mass lesion with smooth margen, low density and homogeneous at the middle mediastinum. Treatment consisted in the resection of the cyst by left thoracic approach. Histologically, the lesion was typical a bronchogenic cyst.

[Bronchoesophageal fistula and broncholithiasis]. / Fístula broncoesofágica y broncolitiasis.

Bronchoesophageal fistulas (BEF) in an adult, whether acquired or congenital, are uncommon but bronchoesophageal perforation secondary to broncholithiasis caused by calcified mediastinal adenopathy and leading to the formation of a fistulous tract is extremely rare. We present a case of acquired BEF in a 57-years-old women who presented cough with expectoration of broncholiths, hemoptysis and cough after swallowing liquid or solid hemoptysis and cough after swallowing liquid or solid foods. The chest film and computed tomographic scan showed calcified mediastinal adenopathy. Endoscopic examination of the esophagus revealed no mucosal abnormality. A bronchial esophageal fistula was identified at the level of the 1/3 midesophagus just below the carina in the esophagogram. The bronchoscopy showed a polypoid area located in the medial side of the right main bronchus. There was no evidence of neoplasm. The patient underwent excision of fistula and interposition of pleural bundle after completing a right posterolateral thoracotomy. The postoperative course was uneventful and the patient has been doing well on follow-up.

[Horner's syndrome associated with a solitary bone plasmacytoma of the first rib]. / Síndrome de Horner asociado a plasmocitoma óseo solitario del primer arco costal.

A case of solitary plasmacytoma originated in the left first rib in a 45-year-male is presented. The initial symptomatology was a Horner's syndrome. A chest X-ray, gammagraphy, TAC and arteriography showed a tumor shadow in the left chest wall; no evidence of plasmacytoma after clinical study found use where. The treatment was surgical excision and postsurgical radiotherapy. The histological investigation revealed a plasmacytoma of the rib. The patient have been followed for two years. The patient is asymptomatic, without evidence of local recurrence and systemic spread of the disease two years after treatment.

[Bochdalek's hernia in an adult with stomach volvulus and extrapulmonary sequestration]. / Hernia de Bochdalek del adulto con volvulación gástrica y secuestro extrapulmonar.

We report a case of Bochdalek's hernia with volvulus of the stomach and extrapulmonary sequestration in an adult. A 27-year-old woman presented acute respiratory failure, pain in the left side of the chest and recurrent vomiting of sudden onset. Upon examination there was pain in the left hypochondrium that was not tolerated in decubitus position. A chest film showed an "arch" at the base on the left side and an upper gastrointestinal series revealed volvulus of the stomach. After a left thoracotomy, the stomach, spleen and greater omentum were found displaced into the thoracic cavity. After the viscera were confined to the abdomen, the hernia was repaired and the pulmonary sequestration was removed. Two years later, the patient was asymptomatic and a chest film was normal.

[Isolated mesenteric fibromatosis]. / Fibromatosis mesentérica aislada.

A case of isolated mesenteric fibromatosis in a forty one years-old male is reported. The patient was symptom-free and no associated disease was detected. In the course of an appendectomy, a tumor was found in the mesentery of the small bowel (jejunum). Surgical excision was performed and the patient is free of recurrence thirteen months later.

[Cyst in the second branchial cleft: review of 3 cases]. / Quiste del segundo arco branquial: a propósito de tres casos.

Three cases of cysts arising from the second branchial cleft are described. They were completely removed. Histopathological examination revealed that cysts were lined with columnar (respiratory type) epithelium. The authors take this opportunity to review the underlying pathogenic mechanism, the clinical manifestations and therapeutic procedures.

Acrodermatitis enteropática y desnutrición proteica posterior a cirugía bariátrica / Enteropathic acrodermatitis and proteic nuttrution after bariatric surgery

La utilización de la cirugía bariátrica ha ido en aumento por su efectividad a largo plazo en el mantenimiento del peso perdido, en la reducción drástica de comorbilidades y mortalidad global. El bypass biliopancreático es una de las técnicas bariátricas más eficaces para la pérdida y mantenimiento del peso con menor restricción dietética. Se presenta un caso clínico de una mujer intervenida previamente de by-pass biliopancreático y que presento signos de malnutrición por deficiencia del zinc. Se describe la evolución de la enferma y se discuten las características y repercusiones que la deficiencia produce en la paciente

The use of bariatric surgery has been increasing due to its long-term effectiveness in maintaining lost weight, in drastically reducing comorbidities and overall mortality. Biliopancreatic bypass is one of the most effective bariatric techniques for weight loss and maintenance with less dietary restriction. We present a clinical case of a woman who had previously undergone biliopancreatic bypass and had signs of zinc malnutrition. The evolution of the patient is described and the characteristics and repercussions that the deficiency produces in the patient are discussed

Estudio comparativo entre clorhexidina alcohólica 2% tintada con aplicador y povidona yodada en la preparación del campo quirúrgico en cirugía limpia de pared abdominal (hernia umbilical y eventración) / Comparative study between alcoholic chlorhexidine 2% tinted with applicator and povidone iodine in the preparation of the surgical field in clean surgery of abdominal wall (umbilical hernia and ventral hernia)

Introducción: existe suficiente evidencia sobre la mayor eficacia de la clorhexidina alcohólica con respecto a la povidona yodada en la asepsia quirúrgica en cirugía limpia-contaminada, pero no la suficiente evidencia en cirugía limpia de pared abdominal. Objetivo: comparar la eficacia en la prevención de la infección del sitio quirúrgico en cirugía limpia de la pared abdominal tras la utilización de estos dos antisépticos en la preparación del campo operatorio. Pacientes y Métodos: estudio observacional retrospectivo. La obtención de datos se ha realizado a través de la historia clínica electrónica. Se seleccionaron 398 pacientes que cumplían los criterios de inclusión, intervenidos de hernia umbilical y eventración desde enero 2017 a diciembre 2018. Se dividieron en dos grupos según el tipo de antiséptico utilizado. Grupo de povidona yodada 199 y grupo de clorhexidina alcohólica 199 pacientes. El criterio de valoración principal es la infección del sitio quirúrgico, en los 30 días posteriores a la cirugía. Se analizaron las frecuencias y distribuciones de variables sexo, edad, antecedentes personales, riesgo anestésico, tipo de intervención, profilaxis antibiótica, tiempo de intervención, presencia de drenaje, estancia y complicación infecciosa. Los resultados se presentan como una media, desviación estándar y varianza para las variables cuantitativas y en proporciones emparentadas para variables cualitativas. La tasa de infección en los dos grupos se compara mediante la prueba del Chi2 con un valor de P < 0,05 como intervalo de confianza, para valorar si la diferencia entre los dos antisépticos, es estadísticamente significativa. El análisis estadístico se realizó mediante el programa SPSS. Resultados: la edad de los pacientes, el sexo, antecedentes personales, riego anestésico, tipo de patología, profilaxis antibiótica, tiempo de intervención, la presencia de drenaje, estancia, el tipo de intervención quirúrgica y el patrón de uso de antibióticos profilácticos en ambos grupos no mostraron diferencias estadísticamente significativas (p> 0.05), lo cual pone de manifiesto la homogeneidad de los grupos y por lo tanto son comparables. Cinco (2,5%) pacientes desarrollaron infección del sitio quirúrgico en el grupo de la povidona yodada y 3 (1,5%) en el grupo de la clorhexidina alcohólica. Las enterobacterias fueron los gérmenes patógenos más frecuentes cultivados en las heridas infectadas. Conclusión: aunque la tasa de infección del sitio quirúrgico en el grupo de clorhexidina alcohólica es menor con respecto al grupo de povidona yodada, el análisis estadístico demuestra que esta diferencia no es estadísticamente significativa (p = 0,7210); por tanto, estos dos antisépticos son igualmente eficaces en la preparación del campo operatorio en cirugía limpia de pared abdominal

Introduction: There is sufficient evidence on the greater efficacy of alcoholic chlorhexidine compared to povidone iodine in surgical asepsis in clean-contaminated surgery, but not enough in clean abdominal wall surgery. Objective: To compare the efficacy in the prevention of infection of the surgical site in clean surgery of the abdominal wall after the use of these two antiseptics in the preparation of the operative field. Patients and Methods: Retrospective observational study. The data collection has been done through the electronic medical record. We selected 398 patients randomly operated on for umbilical hernia and ventral hernia from January 2017 to December 2018. They were divided into two groups according to the type of antiseptic used. Povidone iodine 199 group and alcoholic chlorhexidine group 199 patients. The main endpoint is infection of the superficial surgical site, within 30 days after surgery. We analyzed the frequencies and distributions of sex, age, personal history, anesthetic risk, type of intervention, antibiotic prophylaxis, time of intervention, presence of drainage, stay and infectious complication. The results are presented as a mean, standard deviation and variance for the quantitative variables and in related proportions for qualitative variables. The infection rate in the two groups is compared by the Chi2 test with a P value of < 0.05 as the confidence interval, to assess whether the difference between the two antiseptics in clean surgery is statistically significant. The statistical analysis was carried out using the SPSS pro-gram. Results: The age of the patients, sex, personal history, anesthetic irrigation, type of pathology, antibiotic prophylaxis, time of intervention, the presence of drainage, stay, the type of surgical intervention and the pattern of use of prophylactic antibiotics in both groups did not show statistically significant differences (p > 0.05), which shows the homogeneity of the groups and therefore comparable. Five (2.5%) patients developed surgical site infection in the povidone-iodine group and 3 (1.5%) patients in the alcoholic chlorhexidine group. Enterobacteria were the most frequent pathogens cultured in infected wounds. Conclusion: Although the infection rate of the surgical site in the alcoholic chlorhexidine group is lower with respect to the povidone-iodine group, the statistical analysis shows that this difference is not statistically significant (p = 0.7210); therefore, these two antiseptics are equally effective for the preparation of the operative field in clean abdominal wall surgery

Cilindroma dérmico solitario gigante del cuero cabelludo / Giant solitary dermal cylindroma of the scalp

El cilindroma dérmico es un tumor de los anexos cutáneos con diferenciación apocrina, poco frecuente. Se localizan principalmente en la cabeza y en el cuello. Se clasifica en dos grupos: a) Los esporádico solitarios con un tamaño entre 5 y 10 mm, excepcional-mente pueden adquirir un gran tamaño y b) los múltiples de carácter hereditario, que pueden evolucionar a una gran masa tumoral llamada tumor en turbante, con tendencia a la malignización. Presentamos el caso de un cilindroma solitario gigante en el cuero cabelludo, de una paciente de 89 años de edad de larga evolución y de carácter sintomático. Realizamos una revisión de los aspectos relacionados con las manifestaciones clínicas, diagnóstico, anatomía patológica, diagnóstico diferencial y tratamiento

Cylindrical dermal is a rare tumor of the cutaneous adnexa with apocrine differentiation usually located on head and neck. They are classified into two groups: a) Sporadic solitaires with an average size of 5 y 10 mm, exceptionally they can acquire a large size and b) Multiple hereditary tumors, which can evolve into a large tumor mass called tumor in turban, with tendency to malignancy. We present the case of a giant solitary cylindroma on the scalp of a patient of 89 years-old of long evolution and of asymptomatic character. We carried out a review of the aspects related to the clinical manifestations, diagnosis, pathological anatomy, differential diagnosis and treatment

Vólvulo de ciego secundario a brida epiploica entre colon transverso y anillo inguinal interno izquierdo / Cecal volvulus secondary to epiploic bridle between transverse colon and left internal inguinal ring

El vólvulo cecal es una causa poco frecuente de oclusión intestinal. Generalmente, es causado por exceso de movilidad del ciego. Aunque existen múltiples causas desencadenantes, la presencia de una brida epiploíca sin antecedentes de cirugía abdominal, constituye una etiología excepcional. La presentación clínica es inespecífica y el diagnóstico se confirma mediante TC de abdomen. Presenta un alto índice de mortalidad si no se diagnostica de manera precoz. El abordaje mínimamente invasivo constituye el trata-miento de elección. Presentamos el caso de una paciente de 96 años de edad sin antecedentes de cirugía abdominal, que presentó un cuadro de oclusión intestinal debido a vólvulo cecal secundario a brida epiploíca entre colon transverso y anillo inguinal profundo izquierdo, que requirió una hemicolectomía derecha abierta de urgencia. Realizamos una revisión de los aspectos relacionados con la etiología, fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento

Cecal volvulus is a rare cause of intestinal occlusion. Generally, it is caused by excess mobility of the blind. Although there are multiple triggers causes, the presence of an epiploic bridle without a history of abdominal surgery constitutes an exceptional etio-logy. The clinical presentation is nonspecific and the diagnosis is confirmed by abdominal CT. It has a high mortality rate if it is not diagnosed early. The minimally invasive approach constitutes the treatment of choice. We present the case of a 96-year-old patient withouth a history of abdominal surgery, who presented an acute cecal volvulus secondary to an epiploic bridle between the transverse colon and left internal inguinal ring, which required an emergency right hemicolectomy. We review the aspects related to etiology, physiopathology, clinical manifestations, diagnosis and treatment

[Evaluation of a clinical pathway of the inguinal hernia repair in a general surgery service]. / Evaluación de la vía clínica de la cirugía de la hernia inguinal en un servicio de cirugía general.

OBJECTIVE: The objective of this work is to assess the level of implementation of an inguinal hernia clinical pathway and its impact on the patient satisfaction. MATERIAL AND METHOD: An inguinal hernia repair clinical pathway was introduced in our service in January 2008. We studied all patients included in the clinical pathway since its introduction. The evaluation variables included: level of implementation, indicators of effectiveness in clinical care, and indicators of satisfaction based on a questionnaire. RESULTS: During the first year of introducing the clinical pathway we operated on 582 patients for hernia repair. We excluded 85 cases (14.6%) from the study, due to not fulfilling the inclusion criteria. The study was finally conducted with 497 patients, 49 (9.8%) women and 448 (90.2%) men. The mean age of these patients was 56.6 (21-88) years old. A right hernia repair was performed on 273 cases (54.3%) and 224 (45.7% on the left hernia. In 473 (95.2%) it was a primary hernia and a recurrence in 24 (4.8%). In 441(88.7%) it was a unilateral hernia and 56 (11.3%) a bilateral hernia. The mean length of hospital stay was 1.1 (1-119) days. The level of compliance with length of hospital stay was 96.8%. The level of compliance with surgical prevention was 87.7%. Level of document management by the nursing staff was 86.5% and for doctors it was 80,7%. Overall morbidity was 6%. The informed consent was correctly executed in 97,8% of the cases and 98.6% of patients were given a final report on the day of leaving hospital. A total of 369 satisfaction questionnaires were collected, which was a response rate of 74.2%. Almost all (96%) patients were satisfied with the received information, 87.6% said their pain was managed correctly, and 81% found stay appropriate, and 95% said their hospital stay was between acceptable and good. The level of satisfaction with the care received was 97.5%, and 97.4% of the patients studied would recommend the hospital to a friend or family. CONCLUSION: The introduction of a clinical pathway for inguinal hernia repair has led to a good integration, the services involved in the same. Patients have expressed a high level of satisfaction with the service received, but there are aspects that we must improve: in the information and communication with the patient, the action protocols, evaluation criteria, the VC ¿clinical pathway? Registers, and the satisfaction survey model.

Carcinoma de mama localmente avanzado en la paciente anciana. Diagnóstico y tratamiento: controversias actuales / Locally advanced breast cancer in elderly patient. Diagnosis and treatment: current controversies

El cáncer de mama en pacientes de edad avanzada se produce con frecuencia. La incidencia de los tumores localmente avanzados es mayor en este grupo de edad que en la población más joven. Generalmente es subestimada e infratratada. Presentamos el caso de una paciente octogenaria con esta patología tratada en nuestro servicio. Se realizó mastectomía simple tras constatar la negatividad de la biopsia selectiva del ganglio centinela. Los receptores hormonales fueron altamente positivos. Se indicó tratamiento hormonal coadyuvante. La paciente está libre de enfermedad 6 meses después. El propósito de este trabajo es el de discutir los aspectos relacionados con la epidemiología, diagnóstico y tratamiento de esta entidad

Breast cancer in elderly patients occurs frequently. The incidence of locally advanced neoplasms is higher in this age group than in the younger population and is often underestimated and undertreated. We present the case of an octogenarian patient with this disease treated in our service. Simple mastectomy was made after finding the negativity of selective sentinel node biopsy. Hormone receptors were highly positive. Hormonal treatment was started and the patient is free of disease 6 months later. The aim of this study is to discuss aspects related to epidemiology, diagnosis and treatment of this entity