Evaluating Islet Cell Isolation and Transplantation From Donors Following Medical Assistance in Dying.

Background: Limited information is available regarding outcomes of islet cell isolation (ICI) and transplantation (ITx) using medical assistance in dying (MAiD) donors. We aimed to assess the feasibility and outcomes of ICI and ITx in MAiD donors. Methods: ICI and ITx from MAiD were compared with donation after circulatory death (DCD) type III between 2016 and 2023. Differences of isolated islet equivalents (IEQs), numeric viability and other quantitative in vitro metabolic measures were assessed. Results: Overall, 81 ICIs were available of whom 34 (42%) and 47 (58%) from MAiD and DCD-III, respectively. There were no differences of pancreas and digested tissue weight and islets viability among the 2 groups; however, cold ischemic time was longer in MAiD (11.5 versus 9.1 h; P = 0.021). The IEQ (P < 0.001) and percent trapped (P < 0.001) were higher in the DCD-III; however, MAiD islets demonstrated a higher purity (P = 0.020). Overall, 15 ITx were performed of whom 3 (8.8%) and 12 (25.5%) from MAiD and DCD-III, respectively (P = 0.056). Patients had a median fasting C-peptide of 0.51 ng/mL (interquartile range, 0.30-0.76 nmol/L), with no differences between groups (MAiD = 0.52 versus DCD-III = 0.51; P = 0.718). The median HbA1c was 6.2% (interquartile range, 5.7%-7%) (MAiD = 6.3% versus DCD-III = 6.1%; P = 0.815) and BETA2 scores (MAiD = 7.4 versus DCD-III = 12.8; P = 0.229) did not differ. Conclusions: ICI from MAiD donor pancreas may be successfully transplanted with comparable outcomes to DCD-III and may be used for research. These results justify additional efforts to consider MAiD as another valuable source of grafts for ITx. Further multicenter studies and larger clinical experience are needed to validate our findings.

Observational analysis of clinical and pathological characteristics and their prognostic impact in Mexican patients with breast cancer: A multi-center study.

Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

Clinical symptoms are correlated with gastrojejunal anastomosis complications only during the first year after laparoscopic Roux-en-Y gastric bypass / Los síntomas clínicos se relacionan con las complicaciones de la anastomosis gastroyeyunal solamente durante el primer año después del baipás gástrico laparoscópico

Introduction: after laparoscopic Roux-en-Y gastric bypass (LRYGBP) many patients complain of epigastric pain or food intolerance, leading to the performance of upper gastrointestinal (UGI) endoscopy. Objective: this study aims to assess which symptomatology as reported by LRYGBP patients during follow-up suggested correlation with pathological findings of endoscopy, and which factors might play a role, taking the timing of symptom presentation into account. Materials and methods: a retrospective cohort study was performed identifying LRYGBP patients presenting with food intolerance and/or epigastric pain who had undergone endoscopy. Primary outcomes were endoscopy findings, their association with patient characteristics, and timing of symptom presentation. Results: of the 514 patients complaining of epigastric pain and/or food intolerance, 81 (15.6 %) underwent endoscopy. A gastrojejunostomy complication was found in 58 % of cases. All patients who complained about food intolerance and epigastric pain presented pathological findings. The only preoperative factor associated with a gastrojejunostomy complication was being a smoker (p = 0.021). Time between surgery and endoscopy was also a predictive factor for endoscopic pathological findings (p = 0.007); in cases of epigastric pain, symptom onset during the first year (median: 10 months) was related to increased risk of gastrojejunal complications (p < 0.05). Conclusions: endoscopies performed within one year of surgery were significantly more likely to reveal pathological findings than endoscopies performed after the first postoperative year, especially in patients experiencing epigastric pain. (AU)

Introducción: tras un baipás gástrico laparoscópico en “Y de Roux” muchos pacientes refieren dolor epigástrico o intolerancia alimenticia, lo que motiva la realización de una endoscopia digestiva alta. Objetivos: el objetivo de este estudio es intentar establecer una relación entre la sintomatología referida por los pacientes sometidos a baipás gástrico con los hallazgos endoscópicos patológicos y conocer qué factores pueden estar implicados, considerando el momento de presentación. Material y métodos: estudio retrospectivo de cohortes, identificando a los pacientes sometidos a baipás gástrico laparoscópico que presentan dolor epigástrico o intolerancia alimenticia durante el seguimiento y a los que se realizó una endoscopia digestiva alta. El objetivo primario es relacionar los hallazgos endoscópicos con la sintomatología y el momento de aparición. Resultados: de los 514 pacientes que presentaban dolor epigástrico o intolerancia alimenticia, 81 (15,6 %) fueron sometidos a endoscopia digestiva alta. En un 58 % de los casos se encontraron complicaciones relacionadas con la gastroyeyunostomía. En todos los pacientes que presentaban simultáneamente dolor e intolerancia aparecieron hallazgos endoscópicos patológicos. El único factor preoperatorio relacionado con las complicaciones fue el hábito tabáquico (p = 0,021). El tiempo entre la cirugía y la realización de la endoscopia también fue un factor significativamente relacionado con los hallazgos endoscópicos (p = 0,007). En los casos de dolor epigástrico durante el primer año (media: 10 meses) existía un incremento del riesgo de aparición de complicaciones de la gastroyeyunostomía (p < 0,05). Conclusiones: las endoscopias realizadas durante el primer año postoperatorio tenían más probabilidades de presentar hallazgos patológicos, sobre todo en los pacientes afectos de dolor epigástrico. (AU)

Intraoperative Scintigraphy With Portable Gamma Camera for the Localization of Interaortocaval Paraganglioma.

ABSTRACT: A 15-year-old adolescent girl diagnosed of interaortocaval paraganglioma with a positive 123I-MIGB SPECT/CT and 1 unsuccessful prior surgery was operated on with the assistance of a handheld gamma camera. Once the lesion was located and removed, 2 images were taken, one of the surgical field (without 123I-MIGB uptake) and another of the tumor ex vivo (with high 123I-MIGB uptake), confirming that the lesion had been satisfactorily excised. This case highlights the use of a portable gamma camera as a useful tool to locate this rare tumor, with a SPECT/CT positive for 123I-MIGB and a difficult anatomical location suspected.

Clinical symptoms are correlated with gastrojejunal anastomosis complications only during the first year after laparoscopic Roux-en-Y gastric bypass.

INTRODUCTION: Introduction: after laparoscopic Roux-en-Y gastric bypass (LRYGBP) many patients complain of epigastric pain or food intolerance, leading to the performance of upper gastrointestinal (UGI) endoscopy. Objective: this study aims to assess which symptomatology as reported by LRYGBP patients during follow-up suggested correlation with pathological findings of endoscopy, and which factors might play a role, taking the timing of symptom presentation into account. Materials and methods: a retrospective cohort study was performed identifying LRYGBP patients presenting with food intolerance and/or epigastric pain who had undergone endoscopy. Primary outcomes were endoscopy findings, their association with patient characteristics, and timing of symptom presentation. Results: of the 514 patients complaining of epigastric pain and/or food intolerance, 81 (15.6 %) underwent endoscopy. A gastrojejunostomy complication was found in 58 % of cases. All patients who complained about food intolerance and epigastric pain presented pathological findings. The only preoperative factor associated with a gastrojejunostomy complication was being a smoker (p = 0.021). Time between surgery and endoscopy was also a predictive factor for endoscopic pathological findings (p = 0.007); in cases of epigastric pain, symptom onset during the first year (median: 10 months) was related to increased risk of gastrojejunal complications (p < 0.05). Conclusions: endoscopies performed within one year of surgery were significantly more likely to reveal pathological findings than endoscopies performed after the first postoperative year, especially in patients experiencing epigastric pain.

INTRODUCCIÓN: Introducción: tras un baipás gástrico laparoscópico en "Y de Roux" muchos pacientes refieren dolor epigástrico o intolerancia alimenticia, lo que motiva la realización de una endoscopia digestiva alta. Objetivos: el objetivo de este estudio es intentar establecer una relación entre la sintomatología referida por los pacientes sometidos a baipás gástrico con los hallazgos endoscópicos patológicos y conocer qué factores pueden estar implicados, considerando el momento de presentación. Material y métodos: estudio retrospectivo de cohortes, identificando a los pacientes sometidos a baipás gástrico laparoscópico que presentan dolor epigástrico o intolerancia alimenticia durante el seguimiento y a los que se realizó una endoscopia digestiva alta. El objetivo primario es relacionar los hallazgos endoscópicos con la sintomatología y el momento de aparición. Resultados: de los 514 pacientes que presentaban dolor epigástrico o intolerancia alimenticia, 81 (15,6 %) fueron sometidos a endoscopia digestiva alta. En un 58 % de los casos se encontraron complicaciones relacionadas con la gastroyeyunostomía. En todos los pacientes que presentaban simultáneamente dolor e intolerancia aparecieron hallazgos endoscópicos patológicos. El único factor preoperatorio relacionado con las complicaciones fue el hábito tabáquico (p = 0,021). El tiempo entre la cirugía y la realización de la endoscopia también fue un factor significativamente relacionado con los hallazgos endoscópicos (p = 0,007). En los casos de dolor epigástrico durante el primer año (media: 10 meses) existía un incremento del riesgo de aparición de complicaciones de la gastroyeyunostomía (p < 0,05). Conclusiones: las endoscopias realizadas durante el primer año postoperatorio tenían más probabilidades de presentar hallazgos patológicos, sobre todo en los pacientes afectos de dolor epigástrico.

Eficacia y eficiencia de un programa especial para la disminución de la lista de espera de cirugía bariátrica en un hospital terciario / Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital

Introducción: La cirugía bariátrica es uno de los procedimientos quirúrgicos más realizados en España, sin embargo actualmente es la cirugía con mayor demora en la lista de espera quirúrgica (LEQ). Para disminuir la LEQ se pone en marcha un programa especial de autoconcertación, y se quiere valorar su utilidad, estudiando las repercusiones clínicas y económicas en una unidad de alto volumen de cirugía bariátrica. Métodos: Se realizó un estudio prospectivo de 3 meses comparando evolución, resultados y consumo de recursos perioperatorios de 45 pacientes operados de cirugía bariátrica, divididos en 2 grupos, pacientes operados en quirófano de forma estándar y pacientes operados en programación especial. Se tuvieron en cuenta factores epidemiológicos, asistenciales y económicos. Resultados: Se operaron 2 grupos homogéneos de pacientes, reduciendo con éxito la LEQ. La morbilidad fue similar en ambos grupos y el coste medio de las cirugías realizadas fue de 5.331,4euros, 5372,5±798,1euros para el grupo estándar y 5.290,3±685,1euros para el grupo de programación especial, sin diferencias significativas. Conclusiones: En centros hospitalarios donde se realiza alto volumen de cirugía bariátrica es factible incorporar programas especiales quirúrgicos que permiten la reducción en la demora de las listas de espera quirúrgica, manteniendo los criterios de calidad y sin suponer un mayor gasto al sistema sanitario. (AU)

Introduction: Bariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. Methods: A three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. Results: Two homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. Conclusions: In hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system. (AU)

Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital. / Eficacia y eficiencia de un programa especial para la disminución de la lista de espera de cirugía bariátrica en un hospital terciario.

INTRODUCTION: Bariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. METHODS: A three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. RESULTS: Two homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. CONCLUSIONS: In hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system.

Técnica de "slalom" quirúrgico en estenosis de canal lumbar multinivel. Serie de casos tratados de manera simultánea con descompresión endoscópica y tubular con asistencia microscópica bilateral / Slalom Technique as a treatment in multilevel lumbar spinal stenosis. Series of cases treated simultaneously with endoscopic and tubular decompression with microscopic assistance

Introducción: La laminectomía unilateral para descompresión bilateral por abordaje único ha tomado relevancia en pacientes con estenosis multinivel. Cuando se realiza en más de un nivel por un abordaje único, de manera alterna y de forma cruzada, al abordaje anterior es conocida como técnica de "slalom". Elobjetivode este artículo es presentar una serie de casos tratados con la técnica de "slalom" con asistencia endoscópica y microscópica bilateral, simultánea, en pacientes con estenosis de canal lumbar multinivel.materiales y métodos: Análisis retrospectivo de pacientes tratados de forma simultánea, entre enero de 2017 y enero de 2018, todos operados por el mismo equipo quirúrgico con separadores tubulares, y asistencia endoscópica y micros-cópica simultánea.Resultados: Se incluyó a 4 hombres, con una edad promedio de 73.5 años y patología lumbar multinivel. Se descomprimieron 10 segmentos (2,5 media de niveles por paciente), con un tiempo quirúrgico promedio de 107 minutos. No hubo complicaciones asociadas y los pacientes recibieron el alta hospitalaria el día de la cirugía.Conclusiones:La técnica de "slalom" mínimamente invasiva resulta ser un procedimiento muy eficaz para resolver síntomas de estenosis multinivel asociada a una técnica combinada bilateral con dos equipos quirúrgicos para el tratamiento de este tipo de pacientes. Nivel de Evidencia: IV

Introduction: Unilateral laminectomy for bilateral decompression (ULBD) by single approach has become relevant in patients with multilevel stenosis, when it is performed at more than one level with single approach, alternately and crosswise to the previous approach is known as a slalom technique.The objective of the following work is to present a series of cases treated with the slalom technique with bilateral endoscopic and microscopic assistance, simultaneous in patients with multilevel lumbar canal stenosis. Materials and Methods: Retrospective analysis of patients treated simultaneously between the months of January 2017 to January 2018, all operated by the same surgical team with tubular separators and simultaneous endoscopic and microscopic assistance. Results: Four patients, all male, with an average age of 73.5 years with multilevel lumbar pathology, were included. In total 10 segments were decompressed (2.5 average level for patients), with an average surgery of 107 minutes. No associated complications, with hospital discharge within the day of surgery. Conclusions: The minimally invasive Slalom technique turns out to be a very effective procedure to resolve symptoms of multilevel stenosis associated with a bilateral combined technique with two surgical teams, resulting in a viable option for the treatment of this type of patient. Level of Evidence: IV

Descompresión lumbar en pacientes con enfermedad de Parkinson: serie de casos tratados con cirugía mínimamente invasiva / Lumbar decompression in patients with Parkinson's disease: series of cases treated with minimally invasive surgery

Introducción: La enfermedad de Parkinson afecta principalmente a personas >65 años. El cuadro degenerativo lumbar en el contexto de un canal estrecho sumado a la alteración neuromuscular y la mala calidad ósea, favorece al desequilibrio sagital y coronal. Los pacientes que necesitan cirugía tienen altas tasas de revisión y reoperación con técnicas instrumentadas y no ins-trumentadas. El objetivo de este estudio fue evaluar la técnica quirúrgica de descompresión mínimamente invasiva en pacientes con enfermedad de Parkinson y dolor radicular o claudicación neurogénica en los miembros inferiores. materiales y métodos: Se evaluó a pacientes con diagnóstico de canal lumbar estrecho y enfermedad de Parkinson tratados quirúrgicamente. El procedimiento se indicó por síntomas de canal estrecho o estenosis foraminal de causa degenerativa. Todos fueron tratados con una cirugía descompresiva a través de una hemilaminectomía mínimamente invasiva mediante retracción tubular y asistencia con microscopia. Resultados: De enero de 2015 a diciembre de 2017, se trató a 6 pacientes con enfermedad de Parkinson y canal lumbar estrecho. Se descomprimieron 12 niveles en total, todos estuvieron internados <24 h. No se necesitaron transfusiones, no hubo complicaciones asociadas, el tiempo promedio de cirugía fue de 120 minutos. El seguimiento mínimo fue de 12 meses, los síntomas no reaparecieron. Conclusiones: La elevada tasa de complicaciones en pacientes operados con enfermedad de Parkinson y la disminución de las complicaciones en este estudio sugieren que la cirugía mínimamente invasiva de columna lumbar debería ser una alternativa quirúrgica en estos pacientes. Nivel de Evidencia: IV

Introduction: Parkinson's disease mainly affects patients aged 65 and older. The degenerative condition at the lumbar spine in the context of a narrow canal added to the neuromuscular disorder and poor bone quality favors sagittal and coronal imbalance. Patients who need surgery have high rates of revision and reoperation with instrumented and non-instrumented techniques. The objective of this study was to evaluate the minimally invasive surgical decompression technique in patients with Parkinson's disease and radicular pain or neurogenic claudication in the lower limbs. Materials and Methods: Surgically treated patients with a diagnosis of lumbar spinal stenosis and Parkinson's disease were evaluated. The indication for the procedure was due to symptoms of the lumbar or foraminal stenosis of degenerative cause. All the patients were treated with decompressive surgery through a minimally invasive hemilaminectomy using tubular retraction and assistance with microscopy. Results: From January 2015 to December 2017, 6 patients with Parkinson's disease and lumbar spinal stenosis were treated. A total of 12 segments were decompressed, all patients were hospitalized for less than 24 hours. They did not require a transfusion nor suffered associated complications, with an average surgery time of 120 minutes. All with a minimum follow-up of 12 months and no relapse of the symptoms. Conclusion: The high rate of surgical complications in patients with Parkinson's disease, in contrast to the low rate of complications in the present study, suggests that minimally invasive surgery of the lumbar spine should be a surgical alternative in these patients. Level of Evidence: IV

IRT and GPR Techniques for Moisture Detection and Characterisation in Buildings.

The integrity, comfort, and energy demand of a building can be negatively affected by the presence of moisture in its walls. Therefore, it is essential to identify and characterise this building pathology with the most appropriate technologies to perform the required prevention and maintenance tasks. This paper proposes the joint application of InfraRed Thermography (IRT) and Ground-Penetrating Radar (GPR) for the detection and classification of moisture in interior walls of a building according to its severity level. The IRT method is based on the study of the temperature distribution of the thermal images acquired without an application of artificial thermal excitation for the detection of superficial moisture (less than 15 mm deep in plaster with passive IRT). Additionally, in order to characterise the level of moisture severity, the Evaporative Thermal Index (ETI) was obtained for each of the moisture areas. As for GPR, with measuring capacity from 10 mm up to 30 cm depth with a 2300 MHz antenna, several algorithms were developed based on the amplitude and spectrum of the received signals for the detection and classification of moisture through the inner layers of the wall. In this work, the complementarity of both methods has proven to be an effective approach to investigate both superficial and internal moisture and their severity. Specifically, IRT allowed estimating superficial water movement, whereas GPR allowed detecting points of internal water accumulation. Thus, through the combination of both techniques, it was possible to provide an interpretation of the water displacement from the exterior surface to the interior surface of the wall, and to give a relative depth of water inside the wall. Therefore, it was concluded that more information and greater reliability can be gained by using complementary IRT-GPR, showing the benefits of combining both techniques in the building sector.