Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis.

BACKGROUND: In most cases of diverticulitis, inflammation is mild, and the only treatment required is a clear liquid diet and antibiotics. Until recently, patients were given this treatment as inpatients with the consequent expenditure of resources. The aim of this study was to assess the safety and efficacy of an outpatient treatment protocol with oral antibiotics in selected patients with uncomplicated acute diverticulitis in comparison with inpatient intravenous treatment. METHODS: We conducted a prospective non-randomized study between January 2007 and December 2009. We included all patients diagnosed with uncomplicated acute diverticulitis, at the Emergency Department of the University General Hospital of Elche. We compared the efficacy, safety and costs of hospital treatment with intravenous antibiotics and outpatient treatment with oral antibiotics. Seventy-six patients were included in the study. Forty-four of them underwent intravenous treatment with Metronidazole 500 mg/8 h + Ciprofloxacin 400 mg/12 h (hospital treatment group) and 32 took oral antibiotics Metronidazole 500 mg/8 h and Ciprofloxacin 500 mg/12 h (outpatient group). RESULTS: Outpatient treatment is viable in almost 95 % of those patients suffering from uncomplicated acute diverticulitis. Treatment was effective in resolving inflammation, and there were no complications in the majority of cases (94 %). Only 2 patients (6 %) required admission after outpatient treatment. The results further reflect complications and relapse rates similar to those of patients admitted to hospital and treated with intravenous antibiotics. There are no significant statistical differences (p = 0.86) between inpatients and outpatients. It is possible to save approximately 1,600 € per patient with outpatient treatment (p < 0.05). CONCLUSIONS: Outpatient treatment has demonstrated a safety and efficiency similar to inpatient treatment, producing an important reduction in expenses and medical resources.

Hernia de bochdalek en el anciano. A propóstito de un caso / Bochdalek's hernia in an elderly patient. A Case report

La hernia de Bochdalek es la hernia diafragmática con mayor incidencia. Presentamos el caso de una mujer de 86 años con un cuadro de dolor abdominal, vómitos e insuficiencia respiratoria secundarias a una hernia de Bochdalek gigante (AU)

Bochdalek's hernia is the diaphragmatic hernia with major incidence. We present the case of a 86-year-old woman with a picture of abdominal pain, vomits and respiratory insufficiency secondary to a giant hernia of Bochdalek (AU)

Importancia de una unidad de cirugía mayor ambulatoria en la formación del residente de cirugía general: experiencia en el Hospital General Universitario de Elche / No disponible

Introducción: La cirugía mayor ambulatoria o cirugía sin ingreso permite, en pacientes seleccionados, realizar un tratamiento quirúrgico eficaz, eficiente y seguro sin la necesidad de ingreso hospitalario. Material y método: El Hospital General Universitario de El checuenta con una unidad de cirugía sin ingreso, con 2 quirófanos propios, y un total de 10 sesiones mensuales destinadas al servicio de cirugía general. En dichos quirófanos se realizan intervenciones de pared abdominal, proctología y patología mamaría benigna. Nuestros residentes tienen establecida una rotación continua durante todos los años de la especialidad. Describimos el tipo y número de intervenciones en las que ha participado cada residente, como cirujano o ayudante, comparando los resultados con los mínimos establecidos en el programa de la especialidad durante el periodo2005-2010.Resultados: Durante el periodo a estudio, el total de intervenciones en las que participaron los residentes fue de 3905 (media de154,41 intervenciones por año y residente). De estas intervenciones el 15% como segundo ayudante, el 35% como primer ayudante y el restante 50% como cirujano principal. Discusión: La participación de los residentes en las actividades de cirugía mayor ambulatoria debe estar presente en los programas de formación de los médicos en formación. Estamos ante una parte importante de la cirugía moderna, y como tal, debe ser igualmente parte importante en la formación del futuro cirujano (AU)

Patients and method: The University General Hospital of Elchehas a unit of major ambulatory surgery, 2 own operating rooms, and a total of 10 monthly meetings destined for the general surgery service. In the above mentioned operating rooms there are realized interventions of abdominal wall, proctology and benign breast pathology. Our residents have a constant rotation established during every year of the specialty. We describe the type and number of interventions in which, every resident, has taken part, as surgeon or assistant, comparing the results with the minimums established in the program of the specialty during the period2005-2010.Results: During the period to study, the total of interventions in which the residents took part was of 3905 (average of 154,41 interventions per year and resident). Of these interventions, 15 % like the second assistant, 35 % like the first assistant and the remaining50 % like principal surgeon. Discussion: The participation of the residents in ambulatory surgery activities must be present in the programs of formation of the doctors in formation. We are before an important report of the modern surgery, and as such, it is necessary to be equally an important part in the formation of the future surgeon (AU)

Embolización arterial en aneurisma arteria esplénica / Arterial embolizarion in splenic artery aneurysm

Los aneurismas de la arteria esplénica son infrecuentes y ocurren predominantemente en mujeres. La mayoría son asintomáticos. Presentamos un caso clínico referente a una mujer 42 años con síntomas inespecíficos de dispepsia y estreñimiento. En exámenes rutinarios (TC y ECO) se identificó un aneurisma de arteria esplénica distal de unos 2 cm. Se decidió tratamiento ndovascular con coils.Tras un año de seguimiento la paciente se encontraba asintomática sin complicaciones (AU)

Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until rupture. We report a previously healthy 42 year-old woman who presented with non specific symptoms: dyspepsia and constipation. Laboratory tests were normal. Subsequent examinations (ultrasound and CT) showed a large aneurysm of the splenic artery without any sign of rupture. Endovascular treatment remained successfully performed using coil embolization. During a 12- months follow-up period, the patient was asymptomatic and no evidences of complications or splenic infarction were observed on CT scans (AU)

¿Hernia crural incarcerada? A propósito de un caso / Femoral hernia. Incarcerated? Presentation a Case

La apendicitis aguda es la patología quirúrgica urgente más frecuente. El hallazgo de una apendicitis aguda en una hernia inguinal tiene una incidencia aproximadamente del 0,13%. La presentación clínica depende del grado de inflamación de la apéndice, y frecuentemente se confunde con una hernia incarcerada, siendo reconocida durante la exploración quirúrgica. Presentamos el caso de una hernia de Amyand en una mujer de 67 años (AU)

Acute apendicitis is the most frequent surgical urgent pathology. The finding of a acute appendix in an inguinal hernia has an incidence of approximately 0,13%. The clinical presentation varies, depending on the extent of inflammation of the appendix and is most often misdiagnosed as an incarcerated inguinal hernia. As such it is rarely recognised prior to surgical exploration. We report a case of Amyand’s hernia in an 67 year old woman (AU)

Melanoma rectal: ¿Cuál es el tratamiento correcto? / Anorectal melanoma. What is the correct treatment?

El melanoma maligno primario de localización anorectal es una neoplasia poco frecuente y con una presentación atípica. Los autores presentan un caso y realizan un exhaustivo análisis sobre las consideraciones de su tratamiento quirúrgico (AU)

The primary anorectal malignant melanoma is an infrequent neoplasia with an atypical presentation. The authors have a case presentation and an exhaustive analysis and consideration over to surgical therapy (AU)

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal. Resultados preliminares / Sacral root neuromodulation as treatment for fecal incontinence. Preliminary results

Presentamos nuestra experiencia inicial en el tratamiento de laincontinencia fecal (IF) mediante neuromodulación de raíces sacras(NRS), a través de los resultados de un estudio prospectivo realizadocon 26 pacientes en el que se comparan los valores basales enla escala de continencia de Wexner-Cleveland y en la capacidadpara el retraso de la defecación, con los obtenidos tras un año deterapia con NRS. El estudio inicial de cada paciente incluía anamnesis,exploración general, ecografía y manometría rectal, así comounos diarios de continencia y de calidad de vida específicos para laIF de 3 semanas. Antes de la terapia con NRS, el valor medio en laescala Wexner-Cleveland fue de 15,00 ± 1,81 y el 62,50% de lospacientes tenía una capacidad de retraso de la defecación menorde 1 minuto. Tras un año de terapia con NRS, el valor medio en laescala de Wexner-Cleveland fue de 4,87 ± 2,54 (p = 0,0031) y el75,01% de los pacientes presentaba una capacidad de retraso defecatoriomayor de 15 minutos (p = 0,0018). Hacemos, además,una descripción detalla de la técnica quirúrgica de la NRS, haciendoreferencia a sus indicaciones y finalizamos revisando las distintasopciones terapéuticas para la IF mostrando nuestro algoritmo terapéuticopara esta patología. La NRS es una técnica eficaz para eltratamiento de la IF en pacientes seleccionados que no han respondidoa tratamiento conservador, biofeedback o correcciones anatómicas(esfinteroplastia), con una mínima morbilidad y susceptible derealizarse en un programa de cirugía ambulatoria

We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baselineWexner-Cleveland scale scores and ability to delay defecationwere compard to results after one year with SRN. The initial studyof patients included history taking, general examination, anal ultrasonography,and manometry, and a three-week diary of continenceand quality of life specific for FI was used. Before SRN themean baseline Wexner-Cleveland score was 15.00 ± 1.81, and62.50% of patients could only delay defecation for less than aminute. After a year with NRS the mean Wexner-Cleveland scorewas 4.87 ± 2.54 (p = 0.0031), and 75.01% of patients could delaydefecation above fifteen minutes (p = 0.0018). We also describethe surgical technique and its indications, and finally reviewthe various therapeutical options for FI and show our algorithmfor this condition. SRN is an effective technique for the treatmentof FI in properly selected patients with no response to medicaltherapies (including biofeedback) or anatomic correction (sphincteroplasty),with efficacy, little morbidity, and a short hospital stay

[Sacral root neuromodulation as treatment for fecal incontinence. Preliminary results]. / Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal. Resultados preliminares.

We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compared to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 +/- 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 +/- 2.54 (p = 0.0031), and 75.01% of patients could delay defecation above fifteen minutes (p = 0.0018). We also describe the surgical technique and its indications, and finally review the various therapeutical options for FI and show our algorithm for this condition. SRN is an effective technique for the treatment of FI in properly selected patients with no response to medical therapies (including biofeedback) or anatomic correction (sphincteroplasty), with efficacy, little morbidity, and a short hospital stay.