Resección no planificada en sarcomas de partes blandas del aparato locomotor / Unplanned excision of soft tissue sarcomas of the musculoskeletal system

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system / Resección no planificada en sarcomas de partes blandas del aparato locomotor

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

Unplanned excision of soft tissue sarcomas of the musculoskeletal system. / Resección no planificada en sarcomas de partes blandas del aparato locomotor.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.

Reconstruction Techniques After Partial Nephrectomy: Classic vs. Sutureless Approach-A Narrative Review.

PURPOSE OF REVIEW: The purpose of this review is to update the information about the different types of reconstruction after partial nephrectomy, with special emphasis on the new methods of suture-free hemostasis currently available. RECENT FINDINGS: The aim of renal reconstruction is to avoid bleeding and leakage of the collecting system, but now the renorrhaphy technique used is considered one of the modifiable determinants of renal function after surgery. In an attempt to avoid the loss of renal function implicit in classic reconstruction, new techniques have been described to control hemostasis and urinary leakage, which employ fewer suture layers, different suture materials and designs, and a wide range of commercially available hemostatic materials. Multiple suture characteristics have been studied as a potential factor influencing the renal function observed after partial nephrectomy. Single-plane suture techniques, the use of bearded sutures, and running sutures seem to be associated with less deterioration in postoperative renal function, and deep medullary sutures should be avoided to avoid affecting the arcuate arteries. Sutureless hemostasis systems could prevent the deterioration of renal function and complications derived from suturing, also reducing ischemia time and surgical time without increasing the risk of complications.

Three-year efficacy of switching to dolutegravir plus lamivudine: A real-world study.

BACKGROUND: Dolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real-world, long-term durability studies are lacking. METHODS: We performed a retrospective review of treatment-experienced patients who started DTG + 3TC in a cohort of PWH. HIV-RNA <50 copies/mL was analysed at 144 weeks in an intention-to-treat (ITT) analysis (missing = failure) and a per-protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded). RESULTS: The study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV-RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance-associated mutations (M184V and M184V + R263K). HIV-RNA remained undetectable in 17 patients with a previous history of the M184V mutation. CONCLUSION: Our results confirm the real-world, long-term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment-experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.

Detection of specific RBD+ IgG+ memory B cells by flow cytometry in healthcare workers and patients with inborn errors of immunity after BNT162b2 m RNA COVID-19 vaccination.

Introduction: Inborn errors of immunity (IEI) are a heterogeneous group of diseases caused by intrinsic defects of the immune system. Estimating the immune competence of immunocompromised patients for an infection risk assessment or after SARS-CoV-2 vaccination constituted a challenge. Methods: The aim of this study was to determine the humoral responses of patients with IEI through a comprehensive analysis of specific receptor-binding domain-positive (RBD+) IgG+ memory B cells (MBCs) by flow cytometry, together with routine S-specific IgG antibodies and QuantiFERON SARS-CoV-2 (T-cell response), before the vaccine and 3 weeks after a second dose. Results and discussion: We first analyzed the percentage of specific RBD+ IgG+ MBCs in healthy healthcare workers. Within the control group, there was an increase in the percentage of specific IgG+ RBD+ MBCs 21 days after the second dose, which was consistent with S-specific IgG antibodies.Thirty-one patients with IEI were included for the pre- and post-vaccination study; IgG+ RBD+ MBCs were not evaluated in 6 patients due to an absence of B cells in peripheral blood. We detected various patterns among the patients with IEI with circulating B cells (25, 81%): an adequate humoral response was observed in 12/25, consider by the detection of positive S-specific IgG antibodies and the presence of specific IgG+ RBD+ MBCs, presenting a positive T-cell response; in 4/25, very low S-specific IgG antibody counts correlated with undetectable events in the IgG+ RBD+ MBC compartment but with positive cellular response. Despite the presence of S-specific IgG antibodies, we were unable to detect a relevant percentage of IgG+ RBD+ MBCs in 5/25; however, all presented positive T-cell response. Lastly, we observed a profound failure of B and T-cell response in 3 (10%) patients with IEI, with no assessment of S-specific IgG antibodies, IgG+ RBD+ MBCs, and negative cellular response. The identification of specific IgG+ RBD+ MBCs by flow cytometry provides information on different humoral immune response outcomes in patients with IEI and aids the assessment of immune competence status after SARS-CoV-2 mRNA vaccine (BNT162b2), together with S-specific IgG antibodies and T-cell responses.

Extracción renal en donante cadáver: revisión sistemática de la técnica quirúrgica / Deceased donor kidney procurement: systematic review of the surgical technique

Introducción El proceso de extracción renal debe ser una técnica estandarizada con el fin de optimizar las unidades renales para su posterior implante. Objetivos Revisión de la literatura disponible sobre el proceso de extracción renal. Material y métodos Revisión narrativa de la evidencia disponible sobre la técnica de extracción renal en paciente cadáver tras una búsqueda de los manuscritos relevantes indexados en PubMed, EMBASE y SciELO escritos en español e inglés. Resultados La extracción renal en paciente cadáver se divide en dos grupos, tras muerte encefálica (donation after brain death [DBD]) y tras muerte cardiaca (donation after circulatory death [DCD]). La extracción renal en DBD suele acompañarse de la extracción de otros órganos abdominales y/o torácicos, lo que requiere coordinación quirúrgica multidisciplinar. Durante el proceso de extracción debe asegurarse que los pedículos vasculares renales se mantienen íntegros para su posterior implante y disminuir el tiempo de isquemia. Conclusiones La ejecución adecuada y el perfecto conocimiento de la técnica quirúrgica de extracción y de la anatomía, permite disminuir el índice de pérdidas de injertos relacionados con una incorrecta extracción (AU)

Introduction Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. Objectives Review of the available literatura on kidney procurement procedure. Material and methods Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. Result Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. Conclusions Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques (AU)

Deceased donor kidney procurement: Systematic review of the surgical technique.

INTRODUCTION: Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. OBJECTIVES: Review of the available literature on kidney procurement procedure. MATERIAL AND METHODS: Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. RESULTS: Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. CONCLUSIONS: Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.

¿Qué pasa durante y después del síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2? / What happens during and after multisystem inflammatory syndrome in children associated with SARS-CoV-2?

Objetivo. Analizar las características clínicas y analíticas de los pacientes diagnosticados de síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2 (SIM-PedS) en la Comunidad Autónoma del Principado de Asturias, durante su ingreso y en los seis meses posteriores. Material y métodos. Estudio descriptivo, observacional, prospectivo (diciembre 2020 - junio 2022). Se incluyeron los pacientes menores de 18 años diagnosticados de SIM-PedS en la Comunidad Autónoma del Principado de Asturias. Se recogieron datos demográficos, clínicos y analíticos durante el ingreso y en los seis meses posteriores. Resultados. Durante el periodo de estudio, se incluyeron 16 pacientes (11 varones, edad mediana 10,6 años). Todos los pacientes tuvieron fiebre, 12 clínica gastrointestinal y 12 exantema. Todos los pacientes presentaron elevación de reactantes de fase aguda, 13 elevación de la porción N-terminal del pro-péptido natriurético tipo B, 10 linfopenia y 6 trombopenia. En la evaluación cardiológica durante el ingreso se encontraron alteraciones en seis pacientes. Todos los pacientes recibieron inmunoglobulinas, 14 corticoides y 6 inotrópicos. Nueve pacientes precisaron ingreso en la Unidad de Cuidados Intensivos Pediátricos (UCIP), con una estancia mediana de cuatro días. Un paciente falleció. No se han observado alteraciones reseñables ni en la clínica ni en la analítica ni en la evaluación cardiaca durante los seis meses posteriores al alta. Conclusiones. Los casos recogidos han mostrado las características clínicas y analíticas descritas en la literatura sobre el SIM-PedS, requiriendo más de la mitad ingreso en UCIP y recibiendo en todos los casos tratamiento con inmunoglobulinas. Presentaron frecuentemente afectación cardiológica, falleciendo un paciente. A los seis meses del episodio, ningún paciente ha mostrado afectación clínica, analítica ni de la función cardiaca (AU)

Aim. To analyze the clinical and analytical characteristics of patients diagnosed with Multisystem Inflammatory Syndrome in Children associated with SARS-CoV-2 (MIS-C) in the autonomous community of the Principality of Asturias, during their admission and in the subsequent six months. Material and methods. Descriptive, observational, prospective study (December 2020 - June 2022). Patients under 18 years of age diagnosed with MIS-C in the autonomous community of the Principality of Asturias were included. Demographic, clinical and analytical data were collected during admission and in the following six months. Results. During the study period, 16 patients were included (11 males, median age 10.6 years). All patients had fever, 12 had gastrointestinal symptoms and 12 had rash. All patients presented elevation of acute phase reactants, 13 elevation of the N-terminal portion of B-type natriuretic pro-peptide, 10 lymphopenia and 6 thrombopenia. In the cardiological evaluation during admission, alterations were found in six patients. All patients received immunoglobulins, 14 corticosteroids and 6 inotropes. Nine patients required admission to the Pediatric Intensive Care Unit (PICU), with a median stay of four days. One patient died. No notable alterations have been observed either in clinical symptoms, laboratory tests or cardiac evaluation during the six months after discharge. Conclusions. The cases collected have shown the clinical and analytical characteristics described in the literature on MIS-C, with more than half requiring admission to the PICU and receiving treatment with immunoglobulins in all cases. They frequently presented cardiological involvement, with one patient dying. Six months after the episode, no patient has shown clinical, analytical or cardiac function impairment (AU)

Efecto de la erradicación del VHC sobre la frecuencia crítica de parpadeo en pacientes coinfectados por VIH/VHC con cirrosis avanzada / Effect of HCV eradication on critical flicker frequency in HIV/HCV coinfected patients with advanced cirrhosis

Antecedentes La frecuencia crítica de parpadeo (FCP), definida como la frecuencia a la que un sujeto percibe una luz parpadeante como continua, se asocia directamente con el nivel de alerta del sistema nervioso central. Métodos Mediante el Hepatonorm analyzer (Medi-Business Freiburg GmGH, Germany) hemos estudiado la FCP en el momento basal y tras la erradicación del virus de la hepatitis C (VHC) en 47 pacientes coinfectados por virus de la inmunodeficiencia humana (VIH)/VHC y cirrosis. Los pacientes tenían una edad media de 52 años; el 81% eran varones y el 80% tenía antecedentes de consumo de drogas. Resultados Observamos un incremento en la FCP al final del tratamiento del VHC comparado con el momento basal (42,3 ± 8,5 Hz vs. 45,9 ± 7,8 Hz; p = 0,001), y una reducción en la proporción de pacientes con encefalopatía hepática subclínica (definida como una FCP < 39 Hz) desde 15 (32%) de los 47 pacientes al inicio a 7 (17%) de los 41 pacientes tras el tratamiento del VHC (p = 0,180). Conclusión La erradicación del VHC en pacientes coinfectados por VIH/VHC aumenta la FCP indicando una mejoría de la función hepática (AU)

Background Critical flicker frequency (CFF), defined as the frequency at which a subject perceives a flickering light as continuous, is directly associated with central nervous system alertness. Methods We studied CFF using the Hepatonorm analyzer (Medi-Business Freiburg GmGH, Germany) at baseline and after hepatitis C virus (HCV) eradication in 47 patients with human immunodeficiency virus (HIV)/HCV coinfection and cirrhosis. Patients had a mean age of 52 years, 81% were male, and 80% had a history of drug use. Results We observed an increase in the CFF at the end of HCV therapy compared to baseline (42.3 ± 8.5 Hz vs. 45.9 ± 7.8 Hz; p = 0.001), and a reduction in the proportion of patients with subclinical hepatic encephalopathy (defined as a CFF <39 Hz) from 15 (32%) of 47 patients at baseline to 7 (17%) of 41 patients after HCV therapy (p = 0.180). Conclusion HCV eradication in HIV/HCV coinfected patients increases CFF, indicating improved liver function (AU)

Genetic variants associated with steatohepatitis and liver fibrosis in HIV-infected patients with NAFLD.

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is a common cause of liver damage in people living with HIV (PLWHIV). Several studies have investigated candidate genes for susceptibility to NAFLD and to steatohepatitis. PNPLA3, TM6SF2, and MBOAT7-TMC4 have been reported to be associated with elevated ALT levels and the histologic parameters of nonalcoholic steatohepatitis and severity of fibrosis. Our objective was to analyze the relationship between PNPLA3, TM6SF2, and MBOAT7-TMC4 and steatosis, steatohepatitis, and liver fibrosis in PLWHIV with NAFLD. Method: A cohort of PLWHIV with persistently elevated aminotransferase levels and suspected NAFLD who underwent liver biopsy and determination of genetic variants was assessed at two large centers in Spain. All participants included in the current study were genotyped for rs738409 (PNPLA3), rs58542926 (TM6SF2), and rs641738 (MBOAT7-TMC4). Results: The study population comprised PLWHIV who were on stable antiretroviral therapy [7.7% women; median age, 49.3 years (44-53.4)]. The median CD4 count was 829 (650-980), 60% had metabolic syndrome, and 18.5% were diabetic. The median BMI was 28.9 (25.5-30.8). Patients with liver steatosis (any grade) vs. nonsteatosis tended to harbor the PNPLA3 G allele variant [57.6% vs. 16.7% (p = 0.09)], but not TM6SF2 or MBOAT7-TMC4 variants. However, those with steatohepatitis vs. nonsteatohepatitis significantly more frequently had the PNPLA3 G allele variant [69.4% vs. 39.1% (p < 0.05)] and the MBOAT7-TMC4 A allele variant [75% vs. 42% (p < 0.05)]. In our cohort, the TM6SF2 gene variant was not associated with steatosis or steatohepatitis. The PNPLA3 G allele variant was associated with steatohepatitis [OR 4.9 (1.3-18); p 0.02] and liver fibrosis [OR 4.3 (1.1-17.4); p 0.04], and the MBOAT7-TMC4 A allele variant was associated with steatohepatitis [OR 6.6 (1.6-27.6); p 0.01]. Conclusion: The PNPLA3 G allele variant and MBOAT7-TMC4 A allele variant were associated with steatohepatitis and liver fibrosis in PLWHIV with persistently elevated aminotransferases and NAFLD. We recommend routine genotyping for PNPLA3 and MBOAT7-TMC4 in PLWHIV with NAFLD to identify those at higher risk of progression.

Usefulness of bilateral mucoplasty plus reboot surgery in severe type-2 chronic rhinosinusitis with nasal polyps.

BACKGROUND: Although extended endoscopic sinus surgery (ESS) constitutes an alternative approach in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), the surgical techniques proposed so far do not allow for an optimal control of the disease. This study introduces bilateral mucoplasty as a complementary technique to extended ESS such as reboot surgery, analyzing its benefits in healing and quality of life (QoL). METHODS: Patients diagnosed with severe Type-2 CRSwNP were selected for a prospective cohort study in two surgery groups: reboot surgery plus bilateral mucoplasty versus reboot surgery only. In the first group, an autologous endonasal mucosal graft from the nostril floor was placed bilaterally onto the ethmoidal roof. Endoscopic, radiological and QoL outcomes were compared before and one year after surgery between the two groups using Modified Lund Kennedy (LKM), Meltzer and Lund Mackay (LM) scores, and the Sino-Nasal Outcome Test 22 (SNOT-22). RESULTS: 64 patients with homogeneous baseline characteristics were included: 17 patients underwent a reboot surgery plus a bilateral mucoplasty and 47 a reboot surgery only. LKM, Meltzer and SNOT-22 scores showed significant differences before and after surgery in both groups, with higher improvement in the mucoplasty group. A greater mean improvement of 20.5 ± 6.4 points in SNOT-22 change was associated with bilateral mucoplasty. CONCLUSION: Bilateral mucoplasty plus reboot surgery constitutes a useful surgical resource in Type-2 CRSwNP patients, showing improved endoscopic, radiological and QoL outcomes one year after surgery. Further studies are needed to determine their long-term benefits.

Incidencia de hipopotasemia en pacientes con neutropenia febril que reciben tratamiento con anfotericina B liposomal / Incidence of hypokalemia in patients with febrile neutropenia receiving treatment with liposomal amphotericin B

Objetivos: Describir la incidencia, la gravedad y los factores asociados a la aparición de hipopotasemia en pacientes con neutropenia febril en tratamiento con anfotericina B liposomal.Métodos: Estudio unicéntrico retrospectivo (enero 2010- mayo 2020), que incluyó a aquellos pacientes hematológicos con neutropenia febril que recibieron tratamiento con anfotericina B liposomal durante al menos 72 h. Se evaluó la incidencia de aparición de hipokalemia asociada al empleo del fármaco, la gravedad de la misma, así como el impacto del empleo de una suplementación de potasio sobre la aparición de hipokalemia en este grupo de pacientes.Resultados: Se incluyeron 89 pacientes (50,6% mujeres [n=45]; edad media 63,5 años [20-90]). El 59,6% (n=53) de los pacientes desarrolló hipopotasemia durante el tratamiento con anfotericina B liposomal: leve (52,8%, n=28), moderada (35,8%, n=19) y grave (11,3%, n=6). El empleo de una suplementación de inicio precoz a base de potasio disminuyó la tasa de aparición de hipokalemia en estos pacientes (p=0,001). El periodo entre el inicio del fármaco y el aporte de potasio fue menor en pacientes que no desarrollaron hipokalemia (p<0,001). Asimismo, este grupo de pacientes se benefició de periodos más prolongados de suplementación (p=0,002) y terapia antifúngica (p=0,039).Conclusiones: La hipopotasemia es un efecto adverso muy frecuente en pacientes con neutropenia febril que reciben tratamiento con anfotericina B liposomal, siendo necesario el establecimiento de protocolos de suplementación de potasio que disminuyan el riesgo de aparición de esta reacción adversa. (AU)

Objectives: To describe the incidence, severity and factors associated with the appearance of hypokalemia in patients with febrile neutropenia in treatment with liposomal amphotericin B. Methods: Retrospective unicenter study (January 2010-May 2020), which included those hematological patients with febrile neutropenia who were treated with liposomal amphotericin B for at least 72 h. The incidence of hypokalemia associated with the use of the drug, its severity, and the influence of potassium supplementation on the occurrence of hypokalemia in this group of patients were evaluated. Results: 89 patients were included (50.6% women [n=45]; mean age 63.5 years [20-90]). 59.6% (n=53) of patients developed hypokalemia during treatment with liposomal amphotericin B: mild (52.8%, n=28), moderate (35.8%, n=19) and severe (11.3%, n=6). The use of early-onset potassium-based supplementation decreased the rate of occurrence of hypokalemia in these patients (p=0.001). The period between drug initiation and potassium intake was lower in patients who did not develop hypokalemia (p<0.001). Likewise, this group of patients benefited from longer periods of supplementation (p=0.002) and antifungal therapy (p=0.039).Conclusions: Hypokalemia is a very frequent adverse effect in patients with febrile neutropenia who are treated with liposomal amphotericin B. It is necessary to establish protocols for potassium supplementation to reduce the risk of this adverse reaction. (AU)

Effect of HCV eradication on critical flicker frequency in HIV/HCV coinfected patients with advanced cirrhosis.

BACKGROUND: Critical flicker frequency (CFF), defined as the frequency at which a subject perceives a flickering light as continuous, is directly associated with central nervous system alertness. METHODS: We studied CFF using the Hepatonorm analyzer (Medi-Business Freiburg GmGH, Germany) at baseline and after hepatitis C virus (HCV) eradication in 47 patients with human immunodeficiency virus (HIV)/HCV coinfection and cirrhosis. Patients had a mean age of 52 years, 81% were male, and 80% had a history of drug use. RESULTS: We observed an increase in the CFF at the end of HCV therapy compared to baseline (42.3 ±â€¯8.5 Hz vs. 45.9 ±â€¯7.8 Hz; p = 0.001), and a reduction in the proportion of patients with subclinical hepatic encephalopathy (defined as a CFF <39 Hz) from 15 (32%) of 47 patients at baseline to 7 (17%) of 41 patients after HCV therapy (p = 0.180). CONCLUSION: HCV eradication in HIV/HCV coinfected patients increases CFF, indicating improved liver function.

Técnica PISA: nueva técnica mínimamente invasiva de acceso único para la linfadenectomía pélvica e inguinal en el cáncer de pene / Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer

Objetivos Describir nuestra experiencia inicial con un novedoso abordaje laparoscópico inguinal y pélvico de acceso único mínimamente invasivo para realizar la disección de los ganglios linfáticos (DGL) en el cáncer de pene: la técnica de acceso único pélvico e inguinal (PISA, por las siglas en inglés de Pelvic and Inguinal Single Access).Material y métodos 10 pacientes en diversos estadios de carcinoma de células escamosas de pene (cN0 y ≥ pT1G3 o cN1/cN2) fueron operados mediante la técnica PISA entre 2015-2018. Se realizaron secciones congeladas intraoperatorias de forma rutinaria y se llevó a cabo secuencialmente la DGL pélvica ipsilateral como procedimiento en un solo acto y utilizando las mismas incisiones quirúrgicas ante la detección de ≥ 2 ganglios inguinales(pN2) o extensión ganglionar extracapsular (pN3). Variables: complicaciones posquirúrgicas a 30 días, pérdida de sangre estimada (PSE), tasa de transfusión, tiempo quirúrgico, tiempo hasta la retirada del drenaje y duración de la estancia hospitalaria (DEH). Las medianas y los rangos de los valores de las variables seleccionadas se presentaron como estadísticas descriptivas.Resultados La DGL inguinal fue bilateral en todos los casos y la DGL pélvica fue necesaria en el 40%. El tiempo quirúrgico total fue de 120-170 minutos y la mediana de PSE fue de 66 (30-100) cc. En ningún caso se requirió transfusión sanguínea. No se observaron complicaciones intraoperatorias y la tasa de complicaciones postoperatorias fue del 40% (10% de complicaciones mayores: linfocele inguinal sintomático). La mediana de la estancia hospitalaria fue de 5,8 (3-10) días. La mediana de tiempo hasta la retirada del drenaje inguinal fue de 4,7 días. Número medio de ganglios linfáticos extirpados mediante DGL inguinal: 10,25(8-14). Experiencia retrospectiva de volumen limitado de un centro de referencia con un seguimiento corto.

Objectives To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique.Material and Methods 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. Variables: 30-day postoperative complicactions, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics.ResultsInguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170minutes and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications- symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25(8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills.Conclusions PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications

Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer.

OBJECTIVES: To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique. MATERIAL AND METHODS: 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. VARIABLES: 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics. RESULTS: Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills. CONCLUSIONS: PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.

Complicaciones obstétricas relacionadas con la terapia antirretroviral en gestantes infectadas por el VIH / Obstetric complications related to antiretroviral therapy in pregnant women with HIV infection

IntroducciónEl porcentaje de gestantes infectadas por VIH que demandan embarazo ha aumentado en los países desarrollados debido a la estabilidad de la infección y la disminución de la transmisión vertical por los tratamientos antirretrovirales (TAR) y las medidas preventivas. Sin embargo, existe poca información respecto al efecto del TAR sobre el embarazo.MétodosEstudio retrospectivo de las gestantes infectadas por VIH con TAR controladas en el Hospital La Paz entre los años 2000-2017. Se estudiaron las complicaciones maternofetales.ResultadosSe recogieron 141 gestaciones en 112 mujeres infectadas por VIH. El TAR más utilizado fue la combinación de 2 inhibidores de la transcriptasa inversa análogos nucleosídicos+1 inhibidor de la proteasa (58,1%), con diferencias significativas entre los distintos tratamientos en cuanto a la carga viral plasmática, siendo indetectable en mayor medida con 2 inhibidores de la transcriptasa inversa análogos nucleosídicos +1 inhibidor de la transcriptasa inversa no nucleosídico, segunda pauta más utilizada. Las tasas de neonatos a término de bajo peso (<2.500g) (11,3%), partos pretérmino (11,1%) y rotura prematura de membranas pretérmino (5,6%) fueron mayores que en la población general. Aunque no hubo asociación, estas complicaciones fueron más frecuentes en gestantes con un inhibidor de la proteasa/ritonavir. No se relacionaron con la carga viral plasmática. No se encontró aumento en la tasa de interrupciones gestacionales, malformaciones ni diabetes gestacional.ConclusiónEn las gestantes infectadas por VIH con TAR está aumentada la tasa de neonatos a término de bajo peso, prematuridad y rotura prematura de membranas pretérmino en comparación con la población general, relacionándose especialmente con el tratamiento con un inhibidor de la proteasa, aunque sin asociación significativa.

IntroductionThe percentage of HIV-infected pregnant women seeking pregnancy has increased in developed countries due to the stability of the infection and the decrease in vertical transmission due to antiretroviral treatment (ART) and preventive measures. However, there is little information regarding the effect of ART on pregnancy.MethodsRetrospective study of HIV-infected pregnant women on ART monitored at Hospital La Paz between 2000-2017. Maternal-foetal complications were studied.ResultsOne hundred and forty-one gestations were collected in 112 HIV-infected women. The most commonly used ART was the combination of 2 nucleoside reverse transcriptase inhibitor analogues+1 protease inhibitor (58.1%), with significant differences between the different treatments in terms of plasma viral load being undetectable to a greater extent with 2 nucleoside reverse transcriptase inhibitor analogues+1 non-nucleoside reverse transcriptase inhibitor, the second most used regimen. The rates of low birth weight (<2,500g) term neonates (11.3%), preterm delivery (11.1%) and preterm premature rupture of membranes (5.6%) were higher than in the general population. Although there was no association, these complications were more frequent in pregnant women with a protease inhibitor/ritonavir. They were not related to plasma viral load. No increase in the rate of gestational terminations, malformations or gestational diabetes was found.ConclusionHIV-infected pregnant women on ART have an increased rate of low birth weight, prematurity, and preterm premature rupture of membranes at term compared to the general population, especially related to treatment with protease inhibitor, although without significant association.

Utilidad de la embolización vascular prequirúrgica de tumores renales con trombo tumoral en la vena renal izquierda / Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus

Introducción y objetivos: La embolización prequirúrgica de la arteria renal (EPAR) puede emplearse en grandes masas renales antes de la nefrectomía para simplificar el procedimiento y disminuir el sangrado intraoperatorio. Nuestro objetivo es determinar el papel de la EPAR sobre el sangrado intraoperatorio y las complicaciones postoperatorias en los tumores renales izquierdos con trombo tumoral limitado a la vena renal izquierda (nivel-0).Material y métodosAnálisis retrospectivo de 46 pacientes intervenidos de nefrectomía radical izquierda y trombectomía como tratamiento de un carcinoma de células renales asociado a trombo tumoral de nivel 0 durante el periodo 1990-2020. La EPAR se limitó a aquellos casos en los que el acceso quirúrgico a la arteria renal principal se encontraba a priori dificultado en el estudio de imagen prequirúrgico (n=9; 19,6%). El sangrado intraoperatorio se estimó en base a la tasa de transfusión perioperatoria, y las complicaciones postoperatorias se categorizaron según la clasificación de Clavien-Dindo. Para el contraste de variables se utilizó el test Chi-cuadrado. Se realizó un análisis multivariable para identificar los predictores de transfusión y complicaciones.ResultadosNo existieron diferencias significativas en la tasa de complicaciones global (11,1 vs. 32,4%; p=0,19), complicaciones graves (0 vs. 8,1%; p=0,51), o tasa de transfusión (11,1 vs. 19%; p=0,49) entre ambos grupos (EPAR vs. no-EPAR). En el análisis multivariable la EPAR no se comportó como un predictor de complicaciones (OR: 0,11; IC95% 0,01-2,86; p=0,18) ni de transfusión (OR: 0.46; IC95% 0,02-7,38; p=0,58). (AU)

Introduction and objectives: Preoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0).Material and methodsRetrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990-2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n=9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien-Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications.ResultsThere were no significant differences in the overall complication rate (11.1% vs. 32.4%, P=.19), major complication rate (0% vs.8.1%, P=.51), or transfusion rate (11.1% vs. 19%, P=.49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR:0.11, 95%CI 0.01-2.86; P=.18) nor transfusion (OR:0.46, 95%CI 0.02-7.38;P=.58). (AU)