[Utility of routine use of reversion after sedation in outpatient colonoscopy]. / Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria.

INTRODUCTION: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. AIM: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. MATERIAL AND METHOD: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed. RESULTS: There were no differences between the two groups in age (52.9 +/- 15.5 vs 52.7 +/- 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 +/- 11.7 vs 15.5 +/- 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. CONCLUSION: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room.

[Giant pleomorphic adenoma in accessory salivary gland]. / Adenoma pleomórfico gigante en glándula salival accesoria.

Giant pleomorphic adenoma is the most common neoplasm of salivary glands, specially of parotitis. Less frequently derives from minor salivary glands and, in the case, its size is small. We report one case of pleomorphic adenoma of great mass seated in a palatine salivary gland and avail the opportunity to review these sort of tumors.

[Subcutaneous cervico-thoracic emphysema and pneumo-mediastinum following a tracheostomy]. / Enfisema subcutáneo cervico-torácico y neumomediastino tras traqueotomía.

Reporting the case of a man, 70-year-old, suffering a chronic obstructive lung disease of moderate degree linked to important Reinke's oedema, who underwent a tracheotomy, being troubled the immediate postoperative period with subcutaneous emphysema and pneumomediastinitis, complications resolved favourably in a ten days term, and the patient could be decannulated.

[Post-traumatic carotid cavernous fistula as a cause of objective tinnitus]. / Fístula carotidocavernosa postraumática: origen de acúfenos objectivos.

Reporting the case of a patient, seen in our Hospital Consulting Department, enduring heavy pulsatile tinnitus, following a craniocerebral traumatism. ENT examination was negative, but having the feeling of a carotid-cavernous fistula, angiographies confirmed this pathology. Embolisation of the fistula as treatment stopped the patient's symptomatology. We take the advantage of this case in order to review the etiology, the pathology, diagnostic measure and treatment of this condition.

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose veins.

BACKGROUND: This study was designed with the aim of defining a new surgical procedure for varicose veins and for comparison with classic crossectomy in terms of reducing the recurrence rate of varicose veins. MATERIAL AND METHODS: Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to the Phlebology Consultation Unit meeting inclusion criteria. With their informed consent, they were included in a study group using random table numbers. Group 1: (CS) Classic saphenectomy, 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. Both groups were monitorised at 12 and 24 months by Eco-Doppler study. RESULTS: The incidence of varicose vein recurrence at 12 month follow-up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS it was 29.3% (p <0.0001). These differences, though minor, remained statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common recurrence type was type I, with statistically significant differences at 12 and 24 months. CONCLUSIONS: We believe that saphenectomy with crossectomy without vascular sectioning is the appropriate procedure to treat varicose veins, reducing type 1 or reticular relapse rate and maintaining the principles of classic surgery to reduce type 2 or truncular recurrence rate. This technique should be implemented with procedures based on saphenous sclerosis with foam art the saphenous femoral junction, in order to assess the recurrence rate of type 2 or truncular varicose veins.

Crosectomía alta sin sección vascular frente a safenectomía clásica. Ensayo clínico aleatorizado: análisis de la recidiva varicosa / High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

Fundamento. El presente estudio fue diseñado con el propósito de definir un nuevo procedimiento quirúrgico para la cirugía de las varices y compararlo con estudios de crosectomía clásica en términos de reducir la tasa derecidiva varicosa. Material y métodos. El estudio presentado es un ensayo clínico aleatorizado, doble ciego. Para facilitar el acceso se seleccionaron 150 pacientes que acudieron a consulta Unidad de Flebología, que facilitaron su consentimiento cumpliendo los criterios de inclusión. Se hicieron dos grupos: Grupo 1: safenectomía clásica (CS); 75 pacientes. Grupo 2 : crosectomía alta sin sección vascular (HCWVS) . En ambos grupos el seguimiento se realizó a los 12 y 24 meses por estudio eco- Doppler. Resultados. La incidencia de recidiva varicosa a los 12meses de seguimiento fue de 69,3 % en el grupo de pacientes sometidos a safenectomía clásica, mientras que en el grupo que recibió HCWVS fue 29,3 % (p < 0,0001).Estas diferencias, aunque menores, siguen siendo estadísticamente significativa a los 24 meses de evolución (76 % vs 48 %, p = 0,0004). El tipo más común de recurrencia es del tipo I, con diferencias estadísticamente significativas a los 12 y 24 meses. Conclusiones. La crosectomía alta sin sección vascular tiene una probabilidad global de recurrencia significativamente menor que la safenectomía clásica a los 12 meses (29,3 % frente a 69,3 % ) , que sigue siendo , aunque más pequeña , estadísticamente significativa a los dos años de evolución ( 48 % vs 76 % ) . La tasa de recurrencia del tipo reticular es significativamente menor en el grupo de pacientes sometidos a alta crosectomía sin sección vascular que en los sometidos a safenectomía clásica (AU)

Background. This study was designed with the purpose of defining a new surgical procedure for varicose veins surgery and to be compared with classic crossectomy interms of reducing varicose recurrence rate. Material and methods. Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to Phlebology Unit Consultation, meeting the criteria for inclusion in the study with their informed consent, to be included in a study group using random table numbers table numbers. Group 1: (CS) Saphenectomy classic 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. In both groups the monitoring was conducted at 12 and 24 months by Eco-Doppler study. Results. The incidence of varicose recurrence at 12months follow up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS was29.3% (p <0.0001). These differences, though minor, remain statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common type of recurrence is the type I with statistically significant differences at 12 and 24 months. Conclusions. High crossectomy without vascular section has a global recurrence probability significantly lower than with classic saphenectomy at 12 months (29.3% vs. 69.3%), which remains, though smaller, statistically significant at two years of evolution (48% vs.76%). The recurrence reticular type rate is significantly lower in the group of patients undergoing high crossectomy without vascular section compared to those undergoing saphenectomy with classic crossectomy (AU)

Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria / Utility of routine use of reversion after sedation in outpatient colonoscopy

Introducción: La reversión con flumazenilo ha demostrado, en ensayos clínicos aleatorizados, su eficacia para disminuir el tiempo de estancia de los pacientes en la sala de recuperación tras sedación con midazolam y meperidina. Sin embargo, su efectividad en la práctica clínica diaria no ha sido demostrada, por lo que su uso es muy debatido. Objetivo: Determinar la efectividad de la reversión con flumazenilo tras la sedación consciente con midazolam y petidina en colonoscopia ambulatoria y valorar su relación coste-efectividad. Material y método: Se estudió prospectivamente a 200 pacientes ambulatorios remitidos para colonoscopia y sedados con midazolam y meperidina, procedentes de 2 unidades de endoscopia. Siguiendo la práctica habitual de cada una de las unidades, 100 pacientes fueron revertidos con flumazenilo y 100 no. Se recogieron los datos demográficos y médicos, las indicaciones de la colonoscopia, la dosis de fármacos utilizada y los hallazgos de la endoscopia. Tres semanas después se realizó una encuesta telefónica para determinar las molestias y complicaciones asociadas a la endoscopia o la sedación. Se estudió la relación coste-efectividad. Resultados: No hubo diferencias entre ambos grupos en la edad (52,9 ± 15,5 frente a 52,7 ± 18,3 años; p = NS), en las indicaciones de la colonoscopia, en los hallazgos de la prueba, en el porcentaje de colonoscopias completas (el 93 frente al 95%; p = NS) ni en las dosis de midazolam y meperidina utilizadas. La estancia media en la unidad tras la exploración fue similar (19,2 ± 11,7 frente a 15,5 ± 10,1 min; p = NS). En el grupo de reversión había menos pacientes con estancias prolongadas –estancias de más de 20 min– (el 23 frente al 11%; p < 0,001). El número de pacientes que recordaban molestias durante la exploración era significativamente mayor en el grupo de reversión (el 23 frente al 13%; p < 0,05). No existían diferencias en el número de pacientes con molestias en días posteriores. La mejor relación coste-efectividad se conseguía cuando se buscaba una estancia media de 25 min. Conclusión: La reversión no disminuyó la estancia media en la unidad de endoscopia, pero bajó el número de estancias prolongadas. Los pacientes revertidos experimentan mayores recuerdos desagradables de la exploración. La efectividad del uso de la reversión con flumazenilo tras la sedación con midazolam y meperidina depende de la relación entre el número de exploraciones diarias de la unidad de endoscopia y la capacidad de su unidad de recuperación

Introduction: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. Aim: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. Material and method: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed Results: There were no differences between the two groups in age (52.9 ± 15.5 vs 52.7 ± 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 ± 11.7 vs 15.5 ± 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. Conclusion: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room