The increase in diaphragm thickness in preterm infants is related to birth weight: a pilot study.

Diaphragm ultrasound (DU) has been used in adult and pediatric critical patients in relation to prediction of extubation success or to detect diaphragm dysfunction, but there is a lack of evidence in neonates. Our aim is to study the evolution of diaphragm thickness in preterm infants, as well as related variables. This prospective monocentric observational study included preterm infants born before 32 weeks (PT32). We performed DU to measure right and left inspiratory and expiratory thickness (RIT, LIT, RET, and LET) and calculated the diaphragm-thickening fraction (DTF) in the first 24 h of life and then weekly until 36 weeks postmenstrual age, death, or discharge. Using multilevel mixed-effect regression, we evaluated the influence of time since birth on diaphragm measurements, as well as bronchopulmonary dysplasia (BPD), birth weight (BW), and days of invasive mechanical ventilation (IMV). We included 107 infants, and we performed 519 DUs. All diaphragm thickness increased with time since birth, but the only additional variable that influenced this growth was BW: beta coefficients RIT = 0.00006; RET = 0.00005; LIT = 0.00005; and LET = 0.00004, p < 0.001. Right DTF values remained stable since birth but left DTF increased with time only in infants with BPD.   Conclusion: In our population we found that the higher the BW, the higher diaphragm thicknesses at birth and follow-up. Contrary to the previously published findings in adult and pediatric settings, we were unable to describe a relationship between days of IMV and diaphragm thickness in PT32. The final diagnosis of BPD does not influence this increase either, but it does increase left DTF. What is Known: • Diaphragm thickness and diaphragm thickening fraction have been related to the time on invasive mechanical ventilation in adults and pediatric patients, as well as with extubation failure. • Very few evidence is yet available on the use of diaphragmatic ultrasound in preterm infants. What is New: • Birth weight is the only variable related to diaphragm thickness in preterm infants born before 32 weeks postmenstrual age. • Days of invasive mechanical ventilation do not influence diaphragm increase in thickness in preterm infants.

Experiencia de la cirugía del cáncer de mama durante la pandemia de COVID-19 / Experience of breast cancer surgery during the COVID-19 pandemic

Introducción: La pandemia por COVID-19ha tenido un importante impacto en todos los ámbitos; uno de los más afectados ha sido la sanidad. La pandemia ha supuesto una reorganización de los recursos tanto humanos como materiales, dada la saturación del sistema sanitario. Como especialistas en el cáncer de mama hemos tenido que adaptarnos a esta situación, reorganizando y ajustando los cuidados a los medios profesionales e infraestructuras de los que disponíamos en cada momento. La incidencia variable a lo largo del año ha permitido desarrollar una actividad normalizada en algunas ocasiones. Nos proponemos describir nuestra experiencia en la cirugía del cáncer de mama durante este año de pandemia de COVID-19.Material y métodos: Estudio observacional retrospectivo de pacientes intervenidas de neoplasia de mama desde el 14 de marzo de 2020 hasta el 14 de marzo de 2021.Resultados: Se han intervenido 138 neoplasias de mama en 136 mujeres.La edad media fue de 62 años (36-88). Hubo 86 pacientes (63,2%) en régimen de cirugía mayor ambulatoria y 50 pacientes (36,8%) con ingreso. El tiempo medio desde el diagnóstico hasta la visita en consultas externas fue de 5,7 días y el tiempo medio desde el diagnóstico hasta el inicio del tratamiento de 45 días.Conclusiones: Durante este año de pandemia de COVID-19 hemos podido asegurar la asistencia y tratamiento de las mujeres con cáncer de mama con adecuados intervalos entre el diagnóstico y el tratamiento. A este proceso ha contribuido la implementación previa de la cirugía mayor ambulatoria en el cáncer de mama. (AU)

Introduction: The COVID-19 pandemic has had an important impact in all areas; health service has been one of the most affected. The pandemic has led to a reorganization of human and material resources and has caused a saturation of the health service. As specialists in breast cancer, we have adapted to this situation by reorganizing and adapting care to the professional environments and infrastructures that were available when necessary. The incidence has varied during 2020 and it has made possible to normalize the work on some occasions. We would like to describe our experience in breast cancer surgery during this COVID-19 pandemic year.Material and methods: Retrospective observational study of patients operated on breast cancer from 14th March 2020 to 14th March 2021.Result: A number of 138 breast cancer have been operated on 136 women. The average age is 62 years (36-8); there were 86 patients operated on major ambulatory surgery regimen (63.2%) and 50 patients (36.8%) were hospitalized. The average time from diagnosis to outpatient visit was 5.7 days and the average time from diagnosis to the beginning of the treatment of 45 days.Conclusions: During this COVID-19 pandemic year, we have been able to ensure the care and treatment of women with breast cancer with adequate time intervals between diagnosis and treatment. This process has also been favored by the prior establishment of major ambulatory surgery in our medical center.

Immediate Breast Reconstruction with Prosthesis and Titanized Mesh Using a Dual-Plane Approach: Complications and Risk Factors Analysis.

INTRODUCTION: The immediate breast reconstruction after mastectomy has gained prominence in recent years and is considered one of the main procedures in oncoplastic surgery. In the case of reconstruction with prostheses, the use of a mesh to extend the pectoralis major muscle is often required to partially cover the implant. The main objective of this study was to determine the percentage of complications in immediate breast reconstructions with a titanized mesh using a dual-plane approach and establish risk factors for prosthesis complications and extrusion. MATERIALS AND METHODS: A retrospective study that included women who received postmastectomy reconstructions from January 2012 to December 2019 in a secondary hospital in Spain. RESULTS: A total of 57 immediate reconstructions were performed in 47 women. There were complications in 16 mastectomies (28.1%), of which seven (12.3%) were Clavien-Dindo ≤ IIIa and nine (15.7%) were IIIb. A total of three patients presented prosthetic extrusion, and the prosthesis was removed in five. The degree of contracture according to the Baker scale was I-II in 50 mastectomies (87.7%) and III-IV in seven (12.3%). CONCLUSION: The immediate breast reconstruction with a titanized mesh using a dual-plane approach is a technique with an acceptable percentage of complications. The need for a Wise pattern and the necrosis of the nipple-areola complex in the postoperative period are risk factors for implant loss. Patients undergoing radiotherapy and/or chemotherapy and with a previous surgery are more likely to present capsular contracture. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.

¿Pueden los biomarcadores inflamatorios ayudar al diagnóstico y predecir el pronóstico de la colecistitis aguda gangrenosa? Un estudio prospectivo / No disponible

INTRODUCCIÓN: el diagnóstico de la colecistitis aguda gangrenosa constituye un reto diagnóstico para el médico y en pocas ocasiones se realiza de manera preoperatoria. MATERIAL Y MÉTODOS: presentamos un estudio longitudinal prospectivo de 180 pacientes a los que se les realiza colecistectomía secundaria a colecistitis aguda. Se realiza curva ROC para determinar el punto de corte preoperatorio de diferentes biomarcadores (ratio neutrófilo-linfocito [RNL], proteína C reactiva [PCR], ratio plaqueta-linfocito [RPL], lactato y procalcitonina) y asociación con hallazgos perioperatorios y postoperatorios. RESULTADOS: el área bajo la curva para RNL, PCR, RPL, lactato y procalcitonina fue de 0,75, 0,8, 0,65 y 0,6, respectivamente. CONCLUSIÓN: RNL > 5 y PCR > 100 permanecen como factores independientes de gangrena (odds ratio [OR] ajustada de 2 y 2,1, respectivamente)

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Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study.

The diagnosis of gangrenous acute cholecystitis represents a diagnostic challenge for the physician and is rarely identified preoperatively. We report a longitudinal prospective study in 180 patients who underwent cholecystectomy for acute cholecystitis. A ROC curve was obtained to determine the preoperative cut-off for various biomarkers (neutrophil to lymphocyte ratio [NLR], C-reactive protein [CRP], platelet to lymphocyte ratio [PLR], lactate and procalcitonin) and their association with both preoperative and postoperative findings. The area under the curve (AUC) for NLR, CRP, PLR, lactate and procalcitonin was 0.75, 0.8, 0.65 and 0.6, respectively. NLR > 5 and CRP > 100 are still independent factors for gangrene (adjusted odds ratio [OR], 2 and 2.1, respectively).

Repercusión en el manejo quirúrgico de la ecografía de reevaluación para caracterización de lesiones detectadas en resonancia magnética / Effect on surgical management of second-look ultrasound to characterise lesions detected by magnetic resonance imaging

INTRODUCCIÓN: La ecografía de reevaluación, o de «second-look» (ESL), es útil para caracterizar lesiones de nueva aparición identificadas durante el estudio mediante resonancia magnética (RM). También puede ayudar a optimizar el tratamiento quirúrgico, ya que permite realizar biopsias y obtener un resultado anatomopatológico de las lesiones. El objetivo de este estudio es determinar la utilidad de la ESL para la identificación y la caracterización de lesiones detectadas incidentalmente por RM, así como la repercusión posterior en el manejo quirúrgico. MATERIAL Y MÉTODO: Se realizó un estudio observacional retrospectivo en el que se incluyen mujeres diagnosticadas de cáncer de mama a las que se les realiza ESL tras RM, entre 2013 y 2015. Se recogieron datos epidemiológicos, del tumor primario, características de las lesiones identificadas por RM y posteriormente por ESL, procedimientos quirúrgicos y resultados anatomopatológicos. RESULTADOS: Se identificaron 168 lesiones nuevas mediante RM en 110 pacientes. De ellas, 123 (73,2%) fueron objetivadas posteriormente en la ESL. De acuerdo con el sistema BI-RADS, 88 (71,6%) lesiones se caracterizaron como BI-RADS3 y 24 (19,5%) como BI-RADS4. El resultado de la biopsia tras ESL fue de malignidad en 17 lesiones, lo cual conlleva un cambio de actitud quirúrgica en 15 pacientes. CONCLUSIONES: La ESL puede ser útil para optimizar el tratamiento quirúrgico de las pacientes con cáncer de mama en las que se detecta una nueva lesión mediante RM, permitiendo caracterizar, localizar dicha lesión y realizar biopsias para obtener un resultado anatomopatológico que nos ayude a decidir si es necesaria su exéresis

INTRODUCTION: Second-look ultrasound (SLU) is useful to characterise new lesions identified by magnetic resonance imaging (MRI). SLU may also help to optimise surgical treatment since it allows the performance of biopsies and histopathological analysis of the lesions. The aim of this study was to determine the utility of SLU to identify and characterise lesions initially detected by MRI, as well as its subsequent influence on surgical management. MATERIAL AND METHOD: We performed an observational retrospective study that included women diagnosed with breast cancer who underwent SLU after MRI between 2013 and 2015. We collected data on epidemiological factors, the primary tumour, the characteristics of the lesions identified by MRI and subsequently by SLU, surgical procedures, and histopathological results. RESULTS: A total of 168 new lesions were identified by MRI in 110 patients. Of these, 123 (73.2%) were subsequently identified in SLU. Using the BI-RADS system, 88 (71.6%) lesions were classified as BI-RADS3 and 24 (19.5%) as BI-RADS4. The result of biopsy after SLU was malignancy in 17 lesions, leading to a change of surgical management in 15 patients. CONCLUSIONS: SLU can be useful to optimise the surgical treatment of patients with breast cancer and detection of a new lesion by MRI. SLU allows these lesions to be characterised and localised and biopsies to be taken. This in turn allows histopathological analysis, which helps to determine the need for extirpation of the lesion

Cáncer de mama en pacientes transgénero. Revisión de la literatura / Breast cancer in transgender patients. A review

El término «transgénero» hace referencia a las personas que experimentan su identidad de género de manera diferente del género asignado en el nacimiento. La glándula mamaria representa un claro signo de feminidad e identidad corporal, por lo que su tratamiento adquiere especial relevancia tanto en varones como en mujeres transgénero. Los tratamientos de reasignación de género (hormonales o quirúrgicos) afectarán directamente al tejido glandular mamario, lo que puede afectar al riesgo de presentar un cáncer de mama y modificar así los procesos diagnósticos y terapéuticos. Se realiza en este estudio una revisión y resumen de la literatura científica más relevante sobre este campo, abordando los aspectos clínicos referentes al diagnóstico y el tratamiento de la enfermedad mamaria en pacientes transgénero

The term "transgender" refers to people who experience their gender identity differently from the gender assigned at birth. The mammary gland represents a clear sign of femininity and body identity, so its treatment acquires special relevance in transgender men and women. Gender reassignment treatments (hormonal or surgical) will directly affect the mammary glandular tissue, which may affect the risk of presenting breast cancer and thus modify the diagnostic and therapeutic processes. A review and summary of the most relevant scientific literature on this field is carried out in this study, addressing the clinical aspects related to the diagnosis and treatment of mammary pathology in transgender patients

Adenoma paratiroideo de localización tiroidea en paciente bajo tratamiento prolongado con litio / Intrathyroid parathyroid adenoma in a patient with chronic lithium treatment

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Usefulness of contrast-enhanced US in the diagnosis of acute gangrenous cholecystitis: A comparative study with surgical and pathological findings.

OBJECTIVE: To prospectively determine the usefulness of contrast-enhanced ultrasound (CEUS) in the diagnostic assessment of acute gangrenous cholecystitis, using histopathology as the reference method. MATERIAL & METHODS: The local institutional review board approved the study protocol, and all patients at enrollment provided a written informed consent. From December 2011 to July 2014, all patients with a clinical-sonographic diagnosis of acute cholecystitis underwent a CEUS examination. We included only patients who underwent cholecystectomies within 24-h of CEUS. Radiologists in the course of routine clinical care interpreted the US and CEUS images at the end of the examination, filling out a questionnaire. Two radiologists, blinded to the final diagnosis, independently reviewed the video CEUS sequences for the presence of defects of the gallbladder wall enhancement. Associations between the sonographic findings and histological gangrenous cholecystitis were evaluated by using univariate and multivariate logistic regression analysis. RESULTS: A total of 150 patients were analyzed. The histological diagnoses were 41 (27%) nongangrenous cholecystitis and 109 acute gangrenous cholecystitis (73%). Multivariate analysis of the predictive parameters at univariate analysis revealed that only leukocytosis, diabetes mellitus, lithiasis and defects of wall enhancement on CEUS were independent variables related to gangrenous cholecystitis. The presence of enhancement defects on CEUS enabled the diagnosis of the gangrenous form with sensitivity between 85 and 91% and specificity of 67.5-84.8%. Interobserver agreement for CEUS interpretation was good (median k value: 0.664; range, 0.655-0.680). CONCLUSION: Local or widespread absence of gallbladder wall enhancement on CEUS is associated with the presence of gangrenous acute cholecystitis.

Tratamiento del vólvulo gástrico agudo mediante abordaje laparoscópico / Laparoscopic treatment of acute gastric volvulus

Introducción El vólvulo gástrico es una entidad clínica poco frecuente y se asocia a hernias hiatales tipo ii-iii. Su presentación aguda constituye una urgencia quirúrgica. Pese a su baja frecuencia, ya se han publicado resultados sobre el tratamiento laparoscópico. Material y métodos Estudio retrospectivo de todos los casos diagnosticados de vólvulo gástrico agudo intervenidos por vía laparoscópica desde 1998 a 2010. Se describe la técnica quirúrgica, la evolución postoperatoria y el seguimiento clínico. Resultados Se identificaron 10 casos, uno era un vólvulo primario y el resto secundarios. A 7 pacientes se les realizó una gastropexia anterior como único procedimiento. En los 3 restantes se llevó a cabo fundoplicatura de Nissen y cierre de los pilares con refuerzo protésico. La evolución postoperatoria fue favorable en 9 pacientes, con inicio precoz de la dieta y alta en 48-72h. Con un seguimiento medio de 18 meses, solo hemos constatado una recidiva herniaria radiológica y ninguna recidiva del vólvulo. Conclusión La gastropexia anterior por laparoscopia es, en nuestra experiencia, un procedimiento efectivo y con baja morbilidad para el tratamiento del vólvulo gástrico agudo en pacientes con elevado riesgo quirúrgico (AU)

Introduction Gastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methods A retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. Results A total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. Conclusion Laparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk (AU)

Tratamiento de aneurismas viscerales mediante embolización arterial selectiva y abordaje laparoscópico / Laparoscopic approach in the treatment of visceral aneurysms by selective arterial embolisation

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