Etiología de la mastitis crónica: propuesta de secuencia diagnóstica / Proposed diagnosis sequence for chronic mastitis aetiology

Introducción: Las lesiones inflamatorias mamarias precisan con frecuencia de estudio histopatológico por su capacidad de imitar a los tumores mamarios malignos. El objetivo es proponer una secuencia diagnóstica de las inflamaciones mamarias benignas crónicas. Material y método: Se han revisado en la literatura los métodos y algoritmos diagnósticos de las mastitis crónicas. Resultados: Se propone un algoritmo diagnóstico para los procesos inflamatorios crónicos mamarios. Requiere determinar el patrón histopatológico inflamatorio y su localización, así como un estudio microbiológico apropiado. Posteriormente puede precisar de nuevas pruebas bioquímicas y serológicas orientadas por una correlación clinicopatológica para establecer un diagnóstico específico. Discusión: No se han identificado en la literatura otros algoritmos diagnósticos avalados por estudios de alto nivel de evidencia. Los patrones histopatológicos no son uniformes. Conclusiones: El diagnóstico etiológico precisa identificar patrones histopatológicos inflamatorios benignos y su localización, un estudio microbiológico y pruebas orientadas por correlación clinicopatológica. Se precisan estudios de investigación con niveles de evidencia altos

Introduction: Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast. Material and methods: We reviewed the literature on the diagnostic methods used in chronic mastitis. Results: We propose a diagnostic algorithm for chronic inflammatory processes of the breast. The aetiological diagnosis requires identifying benign inflammatory histopathologic patterns and locations, and microbiological study. New biochemical and serological tests oriented by clinicopathological correlation may then be required to establish a specific diagnosis. Discussion: No diagnostic algorithms based on studies with a high level of evidence have been identified. No uniformity in histopathologic patterns has been described. Conclusions: The etiologic diagnosis requires identifying benign inflammatory histopathologic patterns and locations, microbiological study and tests oriented by clinicopathological correlation. There is a lack of studies with a high level of evidence

Experiencia en la colocación del catéter para diálisis peritoneal por parte de la unidad de cirugía mayor ambulatoria / No disponible

Introducción: Se ha realizado un estudio retrospectivo con el objetivo de demostrar la disminución en la morbilidad de los pacientes con insuficiencia renal crónica, a los que se les implantó un catéter para diálisis peritoneal en el servicio de cirugía mayor ambulatoria, frente a una etapa anterior en la que se realizó de forma no reglada en urgencias. Material y métodos: Los 87 pacientes se distribuyeron en dos grupos: I (julio 1997-abril 2000): 42 intervenidos en urgencias y por personal quirúrgico “no específico” y II (mayo 2000-noviembre 2004): 45 operados en el servicio de CMA. Se han colocado un total de 94 catéteres, 47 en el grupo I y 47 en el II; consumiendo ingreso sólo en el 10% de los pacientes del grupo I. Resultados: En el seguimiento realizado durante las 4 primeras semanas, la infección del orificio de salida del catéter se redujo del 54,75% (grupo I) al 4,5% (grupo II). En cuanto a la incidencia de peritonitis en los primeros 6 meses del implante, se pasó del 28,6% (grupo I) al 2,25% (grupo II). Los desplazamientos del catéter disminuyeron del 21% (grupo I) al 2% (grupo II), así como las hemorragias postcirugía, que del 24% (grupo I) se situaron en un 7% (grupo II). Algo similar sucedió con las fugas de líquido pericatéter, del 11,9% en el I al 4,45% del grupo II, y el desarrollo de eventraciones paraumbilicales, del 19% en el I al 8,9% en el II. Discusión: La UCMA contribuye al bienestar de nuestros pacientes y a la consecución de una adecuada técnica dialítica (AU)

Introduction: A retrospective study has been carried out, having as an objective the demonstration of the decrease in morbidity of patients with chronic renal failure, to whom a catheter for peritoneal dialysis was implanted in the ambulatory major surgery service, against a previous stage in which it was made in anonregulated way in urgencies. Material and methods: The 87 patients were distributed in two groups: I (July 1997-April 2000): 42 persons being operated upon in urgencies by nonspecific surgical personnel and II (May 2000-November 2004): 45 patients operated in the ambulatory major surgery service. A total of 94 catheters have been placed, 47 in group I and 47 in group II; having the need to be hospitalized by only the 10% of the patients from group I. Results: Throughout the monitoring done during the first four weeks, the catheter’s exit orifice’s infection reduced from 54.75% (group I) to 4.5% (group II). According to peritonitis’ incidence in the first 6 months after the implant, it passed from 28.06% (group I) to 2.25% (group II). The catheter’s displacements decreased from 21% (group I) to 2% (group II), as so did the post surgery haemorrhages, which from 24% (group I) went to 7% (group II). A similar situation happened with the pericatheter liquid leaks, from 11.9% in I to 4.45% from group II, and the development of paraumbilical eventrations, from 19% in group I to 8.9% in group II. Discussion: The ambulatory major surgery service contributes to our patients’ wellbeing and to an adequate dialitic technique achievement (AU)

[Correction of the penile curvature in ambulatory surgery]. / Corrección del pene curvo en cirugía mayor ambulatoria.

OBJECTIVE: To evaluate the results obtained in the correction of the curved penis by means of Nesbit's technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. PATIENTS AND METHOD: From January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie's disease) by means of Nesbit's technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. RESULTS: None of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient's process. The degree of satisfaction with the received treatment has been superior to 95%. CONCLUSIONS: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patient's satisfaction.

Corrección del pene curvo en cirugía mayor ambulatoria / Correction of the penile curvature in ambulatory surgery

Objetivo: Evaluar los resultados obtenidos en la corrección del pene curvo mediante la técnica de Nesbit durante los cuatro primeros años de integración de nuestro Servicio en la Unidad de Cirugía Mayor Ambulatoria (CMA) de nuestro Hospital. Pacientes y método: Desde enero de 2000 hasta abril de 2004 hemos intervenido en régimen ambulatorio a 21 pacientes afectos de pene curvo (12 congénito y 9 con enfermedad de Peyronie) mediante la técnica de Nesbit. Se describe el procedimiento quirúrgico-anestésico realizado y también se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. Resultados: Ninguno de los pacientes precisó ingreso por complicación intra ni postoperatoria. Así, hemos tenido una nula incidencia de complicaciones a excepción del inevitable acortamiento del pene, claramente independiente del régimen de ambulatorización del proceso. El grado de satisfacción con el tratamiento recibido ha sido superior al 95%. Conclusiones: La práctica totalidad de los pacientes susceptibles de corrección quirúrgica de incurvación peneana son candidatos a ser incluidos en un programa de CMA, mejorando ostensiblemente la relación costo-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción de los pacientes (AU)

Objective: To evaluate the results obtained in the correction of the curved penis by means of Nesbit’s technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. Patients and method: From January of 2000 to April of 2004 we intervened in ambulatory regime21 patient suffering from curved penis (12 congenital and 9 with Peyronie´s disease) by means of Nesbit’s technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. Results: None of the patients needed entrance for intrasurgery or postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient’s process. The degree of satisfaction with the received treatment has been superior to 95%. Conclusions: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patients’s satisfaction (AU)

La flexión anterior, una posible malposición de la mascarilla laríngea proseal: papel del introductor / Anterior flexion, a posible malpositioning of the proseal laryngeal mask: the roel of the introducer

No disponible

Mascarilla laríngea proseal paracolecistectomía laparoscópica / Proseal laryngeal mask for laparoscopic cholecystectomy

No disponible

Apendicitis aguda en una hernia crural estrangulada. Una variante de la hernia de Amyand / Acute appendicitis in a curral strangulated hernia. Amyand's hernia variant

No disponible

[Systematic recording of perioperative events associated with anesthesia as quality indicator in ambulatory anesthesia]. / Registro sistemático de las incidencias anestésicas perioperatorias como indicador de calidad en anestesia ambulatoria.

OBJECTIVES: To analyze the quality of several anesthetic techniques used for major outpatient surgery in our hospital, by quantifying for each the relative risk (RR) of adverse events during anesthesia and in the postoperative period. PATIENTS AND METHODS: One thousand seventeen patients who underwent surgery between 18 May 1998 and 23 October 1998 were studied retrospectively. RESULTS: The mean age of the patients was 52.27 +/- 24.65 yr; 44.18% were ASA I, 40.56% were ASA II, 14.56% ASA III and 0.67% ASA IV. Mean time of surgery was 33 +/- 16.49 min and mean recovery time until discharge was 77.3 +/- 93.4 min. Admission was necessary for 0.6% of the patients and re-admission for 0.3%. General anesthesia was used with 19%, anesthetic monitoring with 17%, regional anesthesia (including peribulbar) with 46% and local anesthesia plus sedation with 16.6%. In 95% of the cases, no adverse events occurred during anesthesia; in 94.8% no such events occurred during the early recovery period. During surgery and postoperative recovery, intradural anesthesia was associated with significantly greater RR of adverse events in comparison with general anesthesia (6.6 and 2.2 respectively) and in comparison with monitored anesthesia (7.2 and 3.3). No differences in RR were found between general anesthesia and monitored anesthesia. Problems were slight to moderate in severity and mainly related to nausea and vomiting (2%). CONCLUSIONS: Recording perioperative events permits evaluation of the quality of anesthesic procedures. Intradural anesthesia is associated with more complications.

Registro sistemático de las incidencias anestésicas perioperatorias como indicador de calidad en anestesia ambulatoria / Systematic recording of perioperative events related to anesthesia as a quality indicator in outpatient anesthesia

Objetivos. Analizar la calidad de las diferentes técnicas anestésicas empleadas en la unidad de cirugía mayor ambulatoria (UCMA) de nuestro hospital, cuantificando los riesgos relativos (RR) de sufrir incidencias adversas durante la anestesia y el período postoperatorio en cada una de ellas. Pacientes y métodos. Se estudiaron retrospectivamente 1.017 pacientes intervenidos entre el 18/5/98 y el 23/10/98.Resultados. La edad media fue de 52,27 ñ 24,65 años, con un 44,18 por ciento de ASA 1, un 40,56 por ciento de ASA 2, un 14,57 por ciento de ASA 3 y un 0,67 por ciento de ASA 4. El tiempo quirúrgico medio fue de 33 ñ 16,49 min y el tiempo medio de recuperación hasta el alta fue de 77,30 ñ 93,4 min. Se registró un 0,6 por ciento de ingresos y un 0,3 de reingresos. El 19 por ciento de los pacientes recibieron anestesia general, el 17 por ciento cuidados anestésicos monitorizados, el 46 por ciento anestesia regional, incluyendo la anestesia peribulbar, y el 16,6 por ciento anestesia local más sedación. El 95 por ciento de los pacientes no presentaron incidencias durante la anestesia y en el 94,8 por ciento tampoco en el período de recuperación inmediata. La anestesia intradural presentó un significativo aumento del RR de padecer incidencias adversas frente a la anestesia general (6,6 y 2,2) y respecto a los cuidados anestésicos monitorizados (7,2 y 3,3) en los períodos intraoperatorio y postoperatorio, respectivamente. No se objetivó un incremento de los RR entre la anestesia general y los cuidados anestésicos monitorizados. Los problemas fueron de gravedad leve a moderada, destacando un 2 por ciento de náuseas y vómitos. Conclusiones. El registro de las incidencias perioperatorias permite valorar la calidad de los procedimientos anestésicos. La anestesia intradural es la técnica que se asocia a una mayor morbilidad (AU)

No disponible

Remifentanilo en cirugia mayor ambulatoria / Remifentanil in major outpatient surgery

No disponible

[Acute solitary diverticulitis of the cecum, a rare cause of acute abdomen. Apropos of 9 cases and review of the literature]. / Diverticulite aiguë solitaire du caecum une cause rare d'abdomen aigu. A propos de 9 cas et revue de la littérature.

The natural history of colonic diverticulitis rarely includes acute solitary localization in the cecum. Complications are even more rarely seen. We report retrospectively nine cases seen in our unit. There were 5 males and 4 females, mean age 54 years. The patients presented with a more or less painful abdomen with localization in the right iliac region and signs of peritoneal irritation. Physical examination revealed a painful mass in this zone. Fever and hyperleukocytosis were not found in all patients. Barium enema demonstrated signs of pseudocompression of the cecum in four cases suggesting a tumoral formation in two and diverticulitis in the two others. A right hemicolectomy was performed in five patients as peroperative pathological diagnosis could not be ascertained on the macroscopic specimen. Diverticulectomy in the four other patients was unsuccessful in direct relation with the disease course and late diagnosis.