Component separation and large incisional hernia: predictive factors of recurrence.

PURPOSE: To clarify the factors related to recurrence after component separation technique (CST). MATERIALS AND METHODS: A retrospective study was conducted of 381 patients who underwent CST between May 2006 and May 2017 at a tertiary center. All patients had a transverse hernia defect grade W3 in EHS classification. Recurrence rate was determined by clinical examination plus confirmation by abdominal CT scan. RESULTS: At a median of 61.6 months of postoperative follow-up, we reported 34 cases of hernia recurrence (8.9%). On multivariate analysis, BMI > 30 (OR 2.20; CI 1.10-3.91, p = 0.031), immunosuppressive drug use (OR 1.06 CI 1.48-2.75, p = 0.003) and development of surgical site infection (OR 2.7; CI 1.53-4.01, p = 0.002) were factors of recurrence after CST. There was no difference in recurrence rate among repairs of primary and recurrent hernias, urgent repair, operative time, type of prosthesis, or concomitant procedures, even planned or unplanned enterotomies. CONCLUSION: Obesity (BMI > 30), immunosuppressive drug use, and postoperative wound infections were predictors of recurrence after CST.

Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital.

BACKGROUND: An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias. MATERIALS AND METHODS: A total of 351 patients with complex ventral hernias have been treated over a 10-year period. Pre- and postoperative CT scans were performed in all patients. All ventral hernias were W3, according to the EHS classification 1. We analyzed demographic variables, co-morbidities, hernia characteristics, operative, and postoperative variables. RESULTS: One hundred and seventy patients (48.4%) were men; the average age of the study population was 51.6 ± 23.2 years with an average BMI of 32.3 ± 1.3. The hernia was located in the midline in 321 cases (91.5%) versus the flank in 30 (8.5%). In 45 patients, preoperative botulinum toxin (BT) and progressive pneumoperitoneum (PPP) were needed due to giant hernia defects when the VIH/VAC ratio was >20%. Postoperative complications related to the surgical site were seroma (35.1%), hematoma (9.1%), infection (7.2%), and wound necrosis (8.8%). Complications related to the repair were evisceration in 3 patients (1.1%), small bowel fistula in 4 patients (1.5%), 11 cases of mesh infection (2.9%), and abdominal compartment syndrome (ACS) in 2 patients. There were 29 hernia recurrences (8.2%) with a mean follow-up of 31.6 ± 8.1 months. CONCLUSION: The modified CST is an effective strategy for managing complex ventral hernias that enables primary fascial closure with low rates of morbidity and hernia recurrence.

Controversias en el tratamiento del cáncer diferenciado de tiroides. Encuesta a endocrinólogos / Controversies in the treatment of differentiated thyroid cancer. a survey of endocrinologists

Introducción. El objetivo de este trabajo es presentar los resultados de una encuesta sobre el tratamiento del carcinoma diferenciado de tiroides. Método. Al participar en la ponencia “Controversias en el tratamiento del carcinoma diferenciado de tiroides” en el XLIV Congreso Nacional de la Sociedad Española de Endocrinología y Nutrición(SEEN), distribuimos una encuesta entre los endocrinólogos asistentes, que fue contestada por 38 de ellos. Resultados. Ante el diagnóstico de carcinoma papilar (97%) o folicular (100%), la mayoría de los encuestados eligió la tiroidectomía total (TT). Si el diagnóstico era de microcarcinoma papilar, el 84% recomendó que se completara la tiroidectomía si existían factores de riesgo. Con respecto al vaciamiento ganglionar, hubo (..) (AU)

[Perforation of hollow viscera in abdominal injuries]. / Perforación de víscera hueca en traumatismos abdominales.

OBJECTIVE: This is a retrospective study to evaluate our results in the treatment of abdominal trauma. DESIGN: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism. RESULTS: In the cases of blunt trauma 36.8% of injuries were located in the proximal jejunum, 21% in the terminal ileum, 15% in the colon. In the cases of penetrating trauma, small intestinal perforation predominated (46.9%). In 23.5% of the cases the colon was affected. Morbidity in blunt trauma was 38.8% and 0% in penetrating trauma. The mortality in the two groups has been zero. CONCLUSIONS: The most common surgical procedure practised for injuries to the small intestine was simple suture, and for injuries to the colon, colostomy. The most usual surgical procedures in penetrating trauma were simple suture in all small intestine injuries and for colonic lesions half had primary closure and half suture plus colostomy.

[Humoral immunity following splenectomy in adults]. / Inmunidad humoral tras la esplenectomía en el adulto.

Humoral immunity was examined in a population of one hundred adult patients splenectomized after abdominal trauma without associated disease, and the results were compared with those observed in healthy individuals. We found, in addition to the disorders, a large increase in the seric concentration of total IgE, and increased presence of autoantibodies and circulating immunocomplexes. These alterations were not correlated with the asplenia period.

[Splenic hydatidosis: presentation of 8 cases and review of the literature]. / Hidatidosis esplénica: presentación de 8 casos y revisión de la literatura.

A retrospective revision of 8 splenic hydatid cyst cases which underwent surgery in our Department over a period of 19 years is presented. Its rareness, clinical and diagnostic aspects, as well as the association to hydatidosis in other organs are pointed out presenting the results of surgical treatment and patients' evolution.

Cellular immunity in splenectomized patients.

Delayed hypersensitivity and lymphocyte subsets in a group of adult splenectomized patients after abdominal trauma without associated disease have been studied. The results were compared with those observed in healthy individuals. The results show a decreased cutaneous reaction against extracts of Streptococcus and diphtheria antigens. Moreover, an increase in the number of lymphocytes and monocytes was observed, but the T4/T8 ratio was not affected. The impaired cutaneous response against Streptococcus could be related to post-splenectomy sepsis.

[Nonchromaffin neurogenic tumors of the intestinal tract. A report of 2 cases and their relation to von Recklinghausen's neurofibromatosis]. / Tumores neurogénicos no cromafines del tracto intestinal. Aportación de dos casos y estudio de su relación con la neurofibromatosis de von Recklinghausen.

Two patients with neurogenic gastrointestinal tumors are reported. One of them was a gangliocytic paraganglioma of the duodenum. The second one, a jejunal tumors in a patient with Von Recklinghausen's disease (ganglioneuroma). The neural crest origin of these tumours is discussed.

[Breast carcinoma in men: a review of 21 cases]. / Carcinoma mamario en el varón: revisión de 21 casos.

Male breast carcinoma is a truly rare tumor the treatment and prognosis of which have been recently considered similar to female cancer. In this work we reviewed the clinical histories of 21 patients with breast cancer attended in our hospital over a period of fifteen years. Mean age was 60 years. The main cause of consult was the presence of painless nodules most frequently localized in the left breast. We have found a great latency period between the detection of the first symptoms and medical consult (almost 20 months) which by itself justifies that almost fifty percent of patients were either in stage III or IV. Global surveillance was 60% after 5 years excluding other causes of death that were not directly related with the tumor. Statistic analysis did not reveal any significant relationship, probably due to the small number of patients, between the prognosis of the disease and the presence of factors such as cutaneous involvement, duration of symptoms, thelorrhagia, patient age, lymph node [correction of ganglionar] involvement, or deep plane involvement, although a significant relationship (p less than 0.05) was found with TNM stage.

[Primary retroperitoneal tumors. Review of 34 cases]. / Tumores retroperitoneales primarios. Revisión de 34 casos.

Thirty four cases of primary retroperitoneal tumors treated in our hospital during a period of thirteen years are presented. The predominant clinical picture consisted of abdominal pain (57%) and paraneoplasic syndrome (42.8%) with palpable abdominal mass in 79.4% of patients. We highlight the diagnostic value of TAC and ultrasound in these lesions. Surgical treatment was performed in 33 patients, 19 patients underwent radical resection, 3 partial resection and a biopsy was performed in 12 patients. The relapse index after radical surgery was 68.4%. Chemotherapy and/or radiotherapy was given to 70.5% of the patients. The five year survival for solid tumors was 10%.

[Immune thrombocytopenia and HIV-1 infection. Response to splenectomy]. / Trombocitopenia inmune e infección por HIV 1. Respuesta a esplenectomía.

We present a case of thrombocytopenic purpura associated to acquired immunodeficiency; this disease is very infrequently associated to AIDS; the clinical characteristics are similar to the classical Idiopathic Thrombocytopenic Purpura, including the response to splenectomy. We discuss the therapeutic approach of this condition and review the literature, adding this new case of a patient with AIDS, Walter and Reed's stage II, who responded to splenectomy.

[Benefits of splenectomy in the treatment of chronic leukemia]. / Beneficio de la esplenectomía en el tratamiento de las leucemias crónicas.

Both chronic myeloid leukemias (CML) and lymphoid chronic leukemias (LCL) affect the spleen provoking the appearance of symptoms due to the size of the spleen or the sequestration of blood cells. Splenectomy has been utilized to prevent these conditions. We have a series of 12 patients suffering (CML) and 7 suffering LCL with a mean age of 34.4 and 60.14 respectively. All our patients underwent surgery since their splenomegaly did not respond to chemotherapy on radiotherapy with a general worsening of the patients condition. The postsurgery morbidity was greater in patients suffering CML than in those suffering LCL. The most important complications were pulmonary, followed by hemorrhages in the LCL group, and by the presence of fever of unknown origin in the splenectomized LCL patients. There were no fatalities in our series. Clinical and hematological improvement was evident in LCL patients, with increasing hematocrit and platelet number (100% of the cases). The CML results, however, are not so satisfactory, with a complete remission rate of 16.6%. Mortality was very high (83.3%) after a two year follow up, versus 14.3% in LCL, which, could be due to the natural course of the disease. In summary, we believe that splenectomy is a therapeutical approach to consider in all those cases with splenic symptoms improving their quality of life.

[Primary tumors of the small intestine]. / Tumores primarios del intestino delgado.

We made a retrospective analysis of 43 cases of primary tumor of the small intestine, 28 benign and 15 malignant, diagnosed and treated in our hospital over a period of 18 years. A preoperative diagnosis was reached in 13 cases (30%), while in 37.2% the tumor was a casual finding during operation by other methods. The remaining 32.5% debuted as acute abdomen and were an emergency surgical indication. Simple tumoral resection was practiced in 19 cases (44.1%) of benign tumor, intestinal resection with end-to-end anastomosis in 22 cases (51%) and only biopsy in two cases (4.6%). Coadjuvant chemotherapy was given to five patients (11.5%) and radiotherapy to one (2.3%). The one-year survival for malignant tumors was 73%, and only 18% (2 cases) survived more than 5 years after the operation).