Enfermedad de Zuska: fístula crónica mamaria infrecuente / Zuska disease: An uncommon chronic fístula of the breast

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Tratamiento quirúrgico ambulatorio del cáncer de mama. Experiencia en el Hospital General de Ciudad Real / Breast cancer ambulatory surgery. Experience at General Hospital in Ciudad Real

Objetivo. Describir la casuística de pacientes con diagnóstico de cáncer de mama intervenidas en el Hospital General Universitario de Ciudad Real mediante un programa de cirugía mayor ambulatoria (CMA). Pacientes y método. Estudio descriptivo retrospectivo donde se presenta la serie de pacientes del Hospital General de Ciudad Real con diagnóstico de cáncer de mama e intervenidas quirúrgicamente en el periodo comprendido entre el 1 de enero de 2010 y el 1 de febrero de 2011. Resultados. Se intervinieron un total de 130 pacientes; de ellas, un 20% se consideraron larga estancia, un 32,3% corta estancia y un 47,7%, CMA. En el 69,4% de los casos, las técnicas quirúrgicas más asociadas a CMA fueron cirugías conservadoras. Conclusiones. La cirugía del cáncer de mama es factible en programas de cirugía mayor ambulatoria, con criterios establecidos de selección de pacientes. Las técnicas conservadoras fueron las más empleadas en nuestro programa (AU)

Objective. To describe the series of patients diagnosed with breast cancer that went to the operation room in the Ambulatory Surgery Program in the University General Hospital of Ciudad Real. Patients and methods. Retrospective descriptive study of patients diagnosed of breast cancer in University General Hospital of Ciudad Real and had been operated between 01-01-2010 to 01-02-2011. Results. 130 patients were analyzed. 20% were considered long stay more than 72 hours, 32,3% were short stay and 47,7% were ambulatory surgery. Conservative surgery were performed in 69,4% of all the cases included. Conclusion. Breast cancer surgery is feasible in ambulatory surgery programs with patients selection criteria. Conservative techniques were the most common surgery in our program (AU)

Necrosis mamaria bilateral por acenocumarol / Acenocoumarol-induced bilateral breast necrosis

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Determinación rápida intraoperatoria de la paratirina intacta en la cirugía del hiperparatiroidismo primario. La experiencia en nuestro centro / Rapid intraoperative determination of intact parathyroid hormone during surgery for primary hyperparathyroidism. Experience at our center

INTRODUCCIÓN: El hiperparatiroidismo primario (HPTP) se debe a un adenoma único en el 85-95% de las ocasiones, lográndose frecuentemente la curación con la extirpación del mismo. La determinación rápida intraoperatoria de la paratirina intacta (PTHio) puede constituir una herramienta para el control de la efectividad de la cirugía del HPTP. El objetivo principal de nuestro estudio fue evaluar la determinación de PTHio y objetivar si su implementación colaboraba en lograr la aplicación de una cirugía mínimamente invasiva (CMI) y en régimen de cirugía mayor ambulatoria (CMA) en el tratamiento del HPTP. MATERIAL Y MÉTODOS: Estudio retrospectivo de una serie consecutiva de pacientes diagnosticados e intervenidos quirúrgicamente de HPTP en el Hospital General Universitario de Ciudad Real entre enero de 2005 y enero de 2012. RESULTADOS: En el periodo estudiado, se intervinieron 91 pacientes. 39 (42,9%) fueron intervenidos bajo anestesia general y 52 (57,1%) fueron candidatos a anestesia locorregional mediante bloqueo cervical. Del total, 76 (83,5%) fueron subsidiarios de CMI con abordaje unilateral. En el resto se realizó cervicotomía clásica. En 75 pacientes se realizó la determinación de PTHio, de los cuales, en 68 se demostró curación en el mismo acto quirúrgico. El 70,3% (64) de los pacientes fueron intervenidos en régimen de CMA. CONCLUSIONES: La determinación de PTHio puede permitir modificar la estrategia quirúrgica del HPTP en nuestro servicio, colaborando en la realización de una CMI en un porcentaje importante de pacientes, de forma ambulatoria, con alguna mejora estética, probablemente menor dolor, menor ingreso y con menos complicaciones potenciales que en la exploración cervical bilateral

INTRODUCTION: Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT. MATERIAL AND METHODS: Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012.RESULTS: In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients. CONCLUSIONS: Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration

Rapid intraoperative determination of intact parathyroid hormone during surgery for primary hyperparathyroidism. Experience at our center.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT. MATERIAL AND METHODS: Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012. RESULTS: In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients. CONCLUSIONS: Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.

Histiocitoma fibroso maligno. Un sarcoma excepcional en la glándula mamaria / Malignant fibrous histiocytoma. An exceptional sarcoma in the mammary gland

Introducción. El histiocitoma fibroso maligno constituye la neoplasia sarcomatosa más frecuente en los adultos, pero la mama es una localización excepcional. Presentamos el caso de una mujer que comenzó con una tumoración de crecimiento progresivo en la mama derecha. Caso clínico. Mujer de 68 años que consulta por autopalpación de un nódulo en la mama derecha que ha crecido de forma progresiva en los últimos meses. La mamografía y la ecografía muestran una imagen nodular con bordes bien definidos, situada en intercuadrantes superiores de mama derecha, sin adenopatías axilares. Se decidió intervención quirúrgica y el estudio histológico definitivo fue informado como neoformación mesenquimal fusocelular con patrón estoriforme. El estudio inmunohistoquímico fue compatible con un histiocitoma fibroso maligno. Conclusión. Es primordial el diagnóstico diferencial de esta entidad clínica debido a la variabilidad histológica de los tumores sarcomatosos. Sus características clínicas y radiológicas pueden hacerlo pasar desapercibido, pero su comportamiento agresivo hace necesario un diagnóstico precoz, lo cual permitirá un tratamiento adecuado para lograr el aumento en la supervivencia(AU)

Introduction. Malignant fibrous histiocytoma is the most common sarcomatous neoplasm in adults. Localization in the breast, however, is exceptional. We report the case of a woman who presented with progressive tumoral growth in the right breast. Case report. A 68-year-old woman consulted for a self-palpated nodule in the right breast that had grown steadily in the last few months. Mammography and ultrasound showed a nodule with well-defined borders, located in the upper inner quadrant of the right breast. There was no axillary lymphadenopathy. Surgery was performed and the histological examination gave a definitive diagnosis of mesenchymal spindle cell neoplasm with storiform pattern. Immunohistochemical analysis was compatible with a diagnosis of malignant fibrous histiocytoma. Conclusion. Due to the histological variability of sarcomatous tumors, differential diagnosis is paramount in malignant fibrous histiocytoma. Because of their clinical and radiological features, malignant fibrous histiocytoma can be overlooked. Because these tumors are aggressive, an early diagnosis is essential to allow appropriate treatment and to increase survival(AU)

Colecistectomía laparoscópica de puerto único en un programa de CMA / Single port laparoscopic cholecystectomy in major ambulatory surgery (MAS)

Introducción: La cirugía endoscópica por orificios naturales es una nueva modalidad quirúrgica en fase de desarrollo. La vía más natural para los cirujanos es usar una cicatriz ya existente como es el ombligo. La reciente introducción de trocares diseñados para este fin ha hecho posible su puesta en práctica. Material y métodos: En este estudio presentamos nuestra experiencia preliminar en la colecistectomía laparoscópica con puerto de acceso único umbilical, mediante un estudio prospectivo que incluye a 26 pacientes intervenidos entre enero 2009 y enero 2010. También pretendemos conocer su posible realización en régimen de CMA. Resultados: Todos los pacientes presentaban colelitiasis no complicadas, aunque en 5 se identifico una colecistitis en la cirugía. El tiempo quirúrgico promedio fue de 51,2min. La estancia hospitalaria media fue 25,7h. En el 76,92% de los pacientes el ingreso fue menor de 24h. No hubo ningún reingreso ni complicación intraoperatoria o postoperatoria importante. Conclusiones: A la vista de nuestros resultados la colecistectomía laparoscópica por puerto único favorece su inclusión en un programa de cirugía mayor ambulatoria (AU)

Introduction: Natural orifice endoscopic surgery is a new surgical procedure still in the development phase. The most natural entry for surgeons is to use an already existing scar, such as the navel. The recent introduction of trocars designed for this purpose has made it possible to put this into practice. Material and methods: We present our preliminary experience in single trans‐umbilical incision laparoscopic cholecystectomy, by means of a prospective study which included 26 patients operated on between January 2009 and January 2010. We also attempt to find out whether it can be performed in a MAS programme. Results: All patients had uncomplicated cholelithiasis, although in 5 of them cholecystitis was identified during the surgery. The mean surgical time was 51.2min. The mean hospital stay was 25.7h, and 76.92% of patients were admitted for less than 24h. There were no re-admissions or significant intra-operative or post-operative complications. Conclusions: On looking at our results, single port laparoscopic cholecystectomy could be included in a major ambulatory surgery programme (AU)

[Single port laparoscopic cholecystectomy in major ambulatory surgery (MAS)]. / Colecistectomía laparoscópica de puerto único en un programa de CMA.

INTRODUCTION: Natural orifice endoscopic surgery is a new surgical procedure still in the development phase. The most natural entry for surgeons is to use an already existing scar, such as the navel. The recent introduction of trocars designed for this purpose has made it possible to put this into practice. MATERIAL AND METHODS: We present our preliminary experience in single trans-umbilical incision laparoscopic cholecystectomy, by means of a prospective study which included 26 patients operated on between January 2009 and January 2010. We also attempt to find out whether it can be performed in a MAS programme. RESULTS: All patients had uncomplicated cholelithiasis, although in 5 of them cholecystitis was identified during the surgery. The mean surgical time was 51.2 min. The mean hospital stay was 25.7h, and 76.92% of patients were admitted for less than 24h. There were no re-admissions or significant intra-operative or post-operative complications. CONCLUSIONS: On looking at our results, single port laparoscopic cholecystectomy could be included in a major ambulatory surgery programme.