Compared Block Periodized and Non-Periodized Physical Activity Programs in Older Adults.

BACKGROUND: The periodization of physical exercise to optimize objectives is common in competitive sports. However, physical exercise programs for older adults only sometimes present periodization in their programming. Therefore, this article aims to research the results of applying the sports periodized method to older adults. METHODS: A total of 137 participants over 60 years old performed a physical exercise program; 71 participated in a multi-component non-periodized program as the Control Group (CG), and 66 participated in a program periodized in blocks as the Experimental Group (EG). The block periodization program was oriented to the development of strength and was carried out in 86 sessions thrice weekly for eight months. Anthropometric assessments were made using weight, height, Body Mass Index, and electrical bioimpedance; and functional evaluations were made through standardized tests: Short Performance Physical Battery (SPPB), Timed Up & Go (TUG), handgrip, and a two-minute stair test. RESULTS: After the intervention, the EG significantly improved TUG, weight, and BMI. On the other hand, the CG showed significant improvements in fat weight, BMI, and the 2 min stair test. The SPPB did not show changes after the intervention. CONCLUSION: The periodization of physical exercise for older adults does not significantly impact functional capacity in this population group.

Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study.

High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.

Angioleiomioma uterino: a propósito de un caso / Uterine angioleiomyoma: report of clinical case

Resumen El angioleiomioma es un tumor benigno perivascular que raramente se localiza en el útero. Se expone el caso de un angioleiomioma de gran tamaño en una mujer de 30 años con sangrado menstrual abundante y masa abdominal palpable. La paciente fue sometida a miomectomía y diagnosticada de angioleiomioma por el estudio histológico. Ante síntomas persistentes, la angiomiomectomía o la histerectomía simple son eficaces.

Abstract Angioleiomyoma is a benign perivascular tumor that is rarely located in the uterus. This paper presents a case of a large angioleiomyoma in a 30-year-old woman with heavy menstrual bleeding and a palpable abdominal mass. The patient underwent myomectomy and was diagnosed with angioleiomyoma by histological examination. For persistent symptoms, angiomyomectomy or simple hysterectomy are effective.

Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study.

Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.

Tumor fibromixoide osificante maligno supraclavicular / Supraclavicular malignant ossifying fibromyxoid tumor

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Vesícula biliar accesoria con drenaje en el conducto pancreático principal: hallazgos por imagen, manejo quirúrgico y clasificación / Accessory gallbladder joining the pancreatic duct: Diagnostic imaging, surgical management and classification

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Cytomegalovirus colitis: a cause of severe lower gastrointestinal bleeding.

Cytomegalovirus infection is an uncommon illness that mainly affects immunocompromised subjects being associated with high morbidity and mortality rates. Reactivation or reinfection of the virus causes various symptoms ranging from asymptomatic forms to severe organ-specific complications, such as severe lower gastrointestinal bleeding. Once diagnosed the infection it is important and necessary to establish an adequate treatment with antivirals, with the surgical option for those cases with gastrointestinal complications depending on the patients clinical situation. We report two cases of immunocompromised patients that after presenting rectal bleeding, were diagnosed of cytomegalovirus colitis, requiring urgent surgery.

La infección por citomegalovirus es poco frecuente, afecta sobre todo a sujetos inmunocomprometidos y los pacientes de este grupo tienen una alta morbilidad y mortalidad. La clínica de la reactivación o reinfección del virus puede variar desde formas asintomáticas hasta complicaciones graves específicas de órgano, como la hemorragia del tracto gastrointestinal masiva. Es de vital importancia un tratamiento adecuado con antivirales; la opción quirúrgica se reserva para las complicaciones gastrointestinales de acuerdo con la situación clínica del paciente. Se presentan los casos de dos pacientes inmunocomprometidas que luego presentar episodios de rectorragia se diagnostican con colitis por citomegalovirus que exige tratamiento quirúrgico.

La duplicación gástrica en el adulto: una entidad desconocida dentro del espectro de lesiones submucosas gástricas / Adult gastric duplication: an unknown condition within the spectrum of gastric submucosal lesions

Introducción: La duplicación gástrica es una entidad poco frecuente en el adulto que supone solo el 4-8% del total de las duplicaciones gastrointestinales. Consiste en una tumoración quística en el espesor de la pared gástrica rodeada de capa muscular lisa y revestida por mucosa gástrica. Suele ser asintomática, pudiendo presentar síntomas abdominales inespecíficos, así como complicaciones del propio quiste como hemorragias digestivas, úlceras e incluso episodios de pancreatitis. Son difíciles de diferenciar del resto de lesiones submucosas gástricas, ya que pueden simular una tumoración gastrointestinal (GIST) e incluso un quiste mucinoso pancreático. La ecografía endoscópica destaca como método diagnóstico, sin embargo, el diagnóstico definitivo es histológico. Caso clínico: Presentamos el caso de una paciente mujer de 36 años de edad con antecedentes de un episodio de úlcera gástrica perforada 'contenida' que fue manejado de forma conservadora. En la actualidad es diagnosticada de un GIST gástrico, motivo por el cual es intervenida y se le realiza una gastrectomía subtotal laparoscópica con reconstrucción en Y de Roux con buena evolución postoperatoria. Discusión: El diagnóstico histológico definitivo informa de una duplicación gástrica, por lo que el antecedente de úlcera gástrica perforada 'contenida' presentado por la paciente se corresponde con una complicación de la propia duplicación gástrica (AU)

Background: Gastric duplication is an uncommon condition in adults representing only 4-8% of all gastrointestinal duplications. It develops as a cystic growth within the thick gastric wall that is surrounded by a layer of smooth muscle and lined with gastric mucosa. It is usually asymptomatic but may present with nonspecific abdominal symptoms as well as cyst-related complications such as gastrointestinal (GI) bleeding, ulceration and even pancreatitis. They are difficult to distinguish from other gastric submucosal lesions and may also mimic a gastrointestinal tumor (GIST) or mucinous cyst of the pancreas. Endoscopic ultrasound (EUS) is the most widely used diagnostic procedure and histology provides a definitive diagnosis. Case report: We report the case of a 36-year-old female patient with a history of a 'contained' perforated gastric ulcer that was managed conservatively. The patient was diagnosed with a gastric GIST which prompted a laparoscopic subtotal gastrectomy and Roux-en-Y reconstruction with a good postoperative outcome. Discussion: The definitive histological diagnosis was gastric duplication. Thus, the previous diagnosis of a 'contained' perforated gastric ulcer was in fact a complication of the gastric duplication itself (AU)

Adult gastric duplication: an unknown condition within the spectrum of gastric submucosal lesions.

BACKGROUND: Gastric duplication is an uncommon condition in adults representing only 4-8% of all gastrointestinal duplications. It develops as a cystic growth within the thick gastric wall that is surrounded by a layer of smooth muscle and lined with gastric mucosa. It is usually asymptomatic but may present with nonspecific abdominal symptoms as well as cyst-related complications such as gastrointestinal (GI) bleeding, ulceration and even pancreatitis. They are difficult to distinguish from other gastric submucosal lesions and may also mimic a gastrointestinal tumor (GIST) or mucinous cyst of the pancreas. Endoscopic ultrasound (EUS) is the most widely used diagnostic procedure and histology provides a definitive diagnosis. CASE REPORT: We report the case of a 36-year-old female patient with a history of a "contained" perforated gastric ulcer that was managed conservatively. The patient was diagnosed with a gastric GIST which prompted a laparoscopic subtotal gastrectomy and Roux-en-Y reconstruction with a good postoperative outcome. DISCUSSION: The definitive histological diagnosis was gastric duplication. Thus, the previous diagnosis of a "contained" perforated gastric ulcer was in fact a complication of the gastric duplication itself.

Effect of bismuth subgallate on the quality of life in patients undergoing Scopinaro's biliopancreatic diversion.

BACKGROUND: Malabsorptive techniques, such as biliopancreatic diversion, described by Scopinaro, can cause disabling steatorrhea that affects patients' quality of life. Although it usually improves over time, a reduced group of patients can require treatment. The objective of the present study was to assess the effects of bismuth subgallate on the quality of life (QoL) of patients undergoing Scopinaro's biliopancreatic diversion (SBPD) for morbid obesity. The study was conducted at the Hospital Universitario Insular de Gran Canaria, Spain, a public hospital. METHODS: A prospective, observational study in clinical practice was performed to ascertain the effects of bismuth subgallate on QoL in a group of patients undergoing SBPD who reported disabling diarrhea and related odor. Patients received treatment with 2 courses of oral bismuth subgallate, 200 mg every 8 hours for 12 weeks, with a 4-week rest period. Pretreatment and posttreatment surveys were performed. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used, which evaluates symptoms, physical status, emotional status, social performance, and treatment effects. RESULTS: Sixty patients--90% women--with a mean age of 45.6 years were included in the study, 65% of which had superobesity. GIQLI scores obtained at treatment completion were significantly higher--both overall and in the various domains--than those obtained before treatment onset (P<.01). When the morbid obesity and superobesity groups were analyzed separately, a significant increase in the scores for both patient groups was also observed (P< .01). CONCLUSIONS: In clinical practice, treatment with bismuth subgallate resulted in a short-term improvement of QoL for patients undergoing SBPD.

Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure.

BACKGROUND: The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery. OBJECTIVES: The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI). METHODS: Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation. RESULTS: Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients. CONCLUSION: FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.

Reconstrucción diferida del esófago tras su interrupción para el tratamiento de una patología benigna / Staged oesophageal reconstruction for benign disease

Objetivos Evaluar las complicaciones, la mortalidad y la calidad de vida tras la reconstrucción esofágica diferida en pacientes que han precisado desconexión esofágica (esofagostomía cervical) por causas de etiología benigna. Pacientes y métodos Durante el periodo 2002 a 2011, a 20 de 24 pacientes con una exclusión esofágica por patología benigna, se les realizó la reconstrucción diferida. Se analizaron las complicaciones de la reconstrucción y se evaluó la calidad de vida mediante el Cuestionario de la Salud SF-36 antes y después de la cirugía. Resultados Se intervinieron 20 pacientes (16 varones y 4 mujeres) con una edad media de 54,5±10,5 años. Las causas de desconexión esofágica fueron: 10 por ingesta de cáusticos, 3 perforaciones iatrogénicas, 4 dehiscencia de anastomosis y 3 casos con síndrome de Boerhaave. Se realizaron 14 coloplastias (60%) y 6 interposiciones gástricas (25%) en un tiempo medio de 212,2±23,5 días tras la desconexión esofágica. Las complicaciones postoperatorias más frecuentes fueron las respiratorias (55% de los pacientes) y según la clasificación modificada de Clavien se dividieron en: grado 1 (10%), grado 2 (15%), grado 3a (40%), grado 3b (10%) y grado 4a (10%). La mortalidad (grado 5) a los 30 días de la serie fue del 10%. La calidad de vida tras la reconstrucción mejoró de forma significativa en todos los dominios analizados del cuestionario SF-36.ConclusionesLa reconstrucción esofágica en un segundo tiempo se asocia a una elevada morbilidad, con una mortalidad del 10%. Tras la reconstrucción, la calidad de vida mejora en todos los parámetros evaluados (AU)

Objectives To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases. Patients and methods From 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction. Results Twenty patients were operated (16 men and 4 women) with an average age of 54.5±10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2±23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire. Conclusions Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated (AU)

[Staged oesophageal reconstruction for benign disease]. / Reconstrucción diferida del esófago tras su interrupción para el tratamiento de una patología benigna.

OBJECTIVES: To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases. PATIENTS AND METHODS: From 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction. RESULTS: Twenty patients were operated (16 men and 4 women) with an average age of 54.5 ± 10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2 ± 23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire. CONCLUSIONS: Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated.