Las nuevas tecnologías en un hospital del siglo actual. Los Hospitales Universitarios “Virgen del Rocío”apuestan por el presente y por el futuro / New technologies in a Hospital of today´s century. The “Virgen del Rocío” University Hospitals commit themselves to the present and the future

Ante los desafíos actuales, el cirujano del s.XXI debe estar abierto a los nuevos retos que implican la aplicación y desarrollo de las nuevas tecnologías. En su práctica diaria debe aunar la actividad asistencial, la docente y la investigadora, sin olvidar que todas ellas deben ir orientadas hacia la sociedad para la que desempeña su labor. También hoy le es necesario y casi imprescindible, en su quehacer clínico, estar capacitado en el ámbito de la gestión sanitaria. Tenemos que ser gestores de nuestros servicios, de nuestras actividades asistenciales, ser conocedores de una nueva terminología como es la optimización de los recursos, la rentabilidad del trabajo asistencial, así como conseguir los objetivos que nos lleven a mejorar cotas de bienestar y calidad de vida para los usuarios, evitando, dentro de lo posible, el sufrimiento, procurando la resolución de sus procesos y la recuperación de su salud en un espacio relativamente corto de tiempo (AU)

21 st-Century surgeons have to be professionals open to the challenges which the future presents to them given the application and development of new technologies. This article points to surgeons as the managers of their services, their healthcare activities and guarantor of the optimisation of resources and profitability of the healthcare. All this, with the aim of achieving the objectives which lead to better levels of care and quality of life for users of the Surgery Services (AU)

Presentación atípica de tuberculosis peritoneal. Caso clínico diagnosticado por laparoscopia / No disponible

La sospecha clínica de tuberculosis peritoneal debe estar presenteen todo paciente con dolor abdominal de etiología desconocida;sobre todo si se acompaña de fiebre, ascitis y distensión abdominal.El acceso por vía laparoscópica a la cavidad abdominalde forma reglada contribuye de manera primordial al diagnósticotanto por la imagen macroscópica como para la toma de biopsia,que dará posteriormente la confirmación anatomopatológica ymicrobiológica. Ayudando a discriminar entre los posibles diagnósticosdiferenciales que acontecen con clínica similar. Otraspruebas diagnósticas analíticas deben ser tenidas en cuenta paraayudar tanto a la indicación de laparoscopia como de cara al diagnóstico,son tales como la ADA, gammagrafía con Galio-67 y Ca-125

The presence of peritoneal tuberculosis has to be clinically suspectedin all patients with abdominal pain of unknown etiology,particularly when it is accompanied by fever, ascites, and abdominaldistension. Access to the abdominal cavity using routine laparoscopyprovides essential information on the diagnosis, fromboth macroscopic images and biopsy sampling, which will laterprovide a pathological and microbiological confirmation. Thishelps discriminate between potential differential diagnoses thatmay include similar symptoms. Other laboratory tests have to beconsidered as diagnostic aids, as well as for the indication of laparoscopy,including ADA, and Gallium-67 or Ca-125 scans (AU)

Íleon perforado y fistulizado a piel contenido en gran hernia umbilical incarcerada / Perforated, fistulized-to-skin ileum within a large incarcerated umbilical hernia

No disponible

Desviación del eje cardiaco por una recidiva local mediastínica de un liposarcoma retroperitoneal / Shift of the heart axis due to mediastinum recurrence of a retroperitoneal liposarcoma

No disponible

Adenocarcinoma de cuarta porción de duodeno en paciente con poliposis adenomatosa familiar / Adenocarcinoma in the fourth portion of duodenum in a patient with familial adenomatous polyposis

No disponible

[Atypical peritoneal tuberculosis. Use of laparoscopy in the diagnosis]. / Presentación atípica de tuberculosis peritoneal. Caso clínico diagnosticado por laparoscopia.

The presence of peritoneal tuberculosis has to be clinically suspected in all patients with abdominal pain of unknown etiology, particularly when it is accompanied by fever, ascites, and abdominal distension. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis, from both macroscopic images and biopsy sampling, which will later provide a pathological and microbiological confirmation. This helps discriminate between potential differential diagnoses that may include similar symptoms. Other laboratory tests have to be considered as diagnostic aids, as well as for the indication of laparoscopy, including ADA, and Gallium-67 or Ca-125 scans.

Hernia paraduodenal izquierda atípica / Atypical left paraduodenal hernia

No disponible

[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

International scientific production in digestive laparoscopic surgery.

OBJECTIVE: To obtain data on research in laparoscopic digestive surgery over the period of 1991 to 1996. MATERIAL AND METHODS: We used Medline and the Science Citation Index to obtain general data on production. For more specific data (contents, etc.) we used random samples with a confidence level of 99%. RESULTS: There were 4825 publications on laparoscopic digestive surgery and 4.085 on other specialties; of these, articles represented 85% and editorials and letters 15%. University hospitals published 40% of this production. The producing countries were USA (45%), France (8.2%), United Kingdom (7.9%) and Germany (7.5%). The publishing countries were USA (41%), Germany (15.3%), United Kingdom (9.7%) and France (6.7%). The publication with the largest influence was the New England Journal of Medicine with a total Impact Factor of 589; the British Journal of Surgery with a factor of 436, Archives of Surgery with 343, American Journal of Surgery with 336 and Annals of Surgery with 302; the mean relative Impact Factor was 1.886. Method was involved in 756 retrospective studies, 275 prospective studies and 43 random clinical trials; the rest were not series. The majority of contents are on techniques and instruments, indications and general reflections. The most researched anatomical region was the gall bladder, followed by the bile ducts and the colon. The differences had a "z" > 1.645, that is to say, p < 0.05, and so considered statistically significant. CONCLUSIONS: The largest production and publication takes place in the USA and the journal with the greatest influence is the New England. Important studies on method are extremely scarce, random clinical trials representing only 1%.

Producción científica internacional en cirugía digestiva laparoscópica / International scientific production in di gestive laparoscopic surgery

Objetivo: obtener datos sobre la investigación en cirugía digestiva laparoscópica, en los años 1991 a 1996.Material y métodos: usamos Medline y Science Citation Index para obtener los datos generales de producción; para los datos específicos (contenidos, etc.) utilizamos muestras aleatorias con nivel de confianza del 99 por ciento. Resultados: hay 4.825 publicaciones de cirugía digestiva laparoscópica y 4.085 de otras especialidades; son artículos el 85 por ciento, editoriales y cartas el 15 por ciento. Los hospitales universitarios publican un 40 por ciento. Los países productores son EE.UU. (45 por ciento), Francia (8,2 por ciento), Reino Unido (7,9 por ciento) y Alemania (7,5 por ciento). Los países editores son EE.UU. (41 por ciento), Alemania (15,3 por ciento), Reino Unido (9,7 por ciento) y Francia (6,7 por ciento). La mayor influencia la logra el N e w England Journal of Medicine, consiguiendo un factor de impacto total de 589; British Journal of Surgery 436, A r c h i v e s of Surgery 343, American Journal of Surgery 336 y A n n a l s of Surgery 302; el impacto medio relativo es de 1.886. Metodológicamente hay 756 estudios retrospectivos, 275 prospectivos y 43 ensayos clínicos aleatorizados; el resto no son series.Los contenidos mayoritarios son sobre técnicas e instrumental e indicaciones y reflexiones en general. La región anatómica más investigada es la vesícula biliar, seguida de las vías biliares y colon. Las diferencias tienen "z" > 1,645, es decir, p <0,05, por lo que son estadísticamente significativas. Conclusiones: la mayor producción y edición la realiza EE.UU. y la mayor influencia la consigue el New England. Son escasos los estudios metodológicamente importantes, siendo los ensayos clínicos aleatorizados sólo un 1 por ciento (AU)

Tratamiento laparoscópico de la hernia de hiato y del reflujo gastresofágico / Laparoscopic treatment of hiatal hernia and gastroesophageal reflux

Introducción. El tratamiento laparoscópico de la enfermedad por reflujo gastroesofágico se acompaña de importantes ventajas clínicas, aunque existen algunos puntos controvertidos: una correcta indicación quirúrgica, el tipo de funduplicatura más apropiada en virtud de los estudios preoperatorios y el valor que tienen ciertos detalles técnicos. Pacientes y método. Hemos practicado una funduplicatura a 176 pacientes, con un rango de edad entre 22 y 78 años. La indicación de cirugía incluyó: intratabilidad médica, pacientes jóvenes y hernia paraesofágica. La sintomatología predominante fue: reflujo (93 por ciento), disfagia (38 por ciento), dolor torácico (18 por ciento) y síntomas respiratorios (4 por ciento). Nuestra serie incluye 27 casos (15 por ciento) de enfermedad por reflujo gastroesofágico sin hernia asociada, 119 (67 por ciento) de hernia de hiato axial, 14 (8 por ciento) de hernia de hiato paraesofágica y 16 (9 por ciento) de hernia de hiato mixta. A todos los pacientes se les practicó un estudio baritado gastroduodenal, endoscopia en 88 (50 por ciento), pH-metría, en 140 (89 por ciento) y manometría en 146 (92 por ciento). Resultados. Las técnicas utilizadas fueron: Nissen-Rosetti en 114 casos (65 por ciento), Toupet en 55 (31 por ciento) y Dor en 6 (3 por ciento). Se seccionaron los vasos cortos en 7 casos (4 por ciento). El índice de complicaciones intraoperatorias fue del 1,7 por ciento, la tasa de conversión del 1,7 por ciento y la tasa de reintervenciones del 1,1 por ciento. En todos los casos se controló la sintomatología de reflujo. El 60 por ciento de los pacientes no presentaron disfagia, el 29 por ciento, disfagia leve ( 4 semanas) y el 0,63 por ciento disfagia grave. Seis pacientes (3,41 por ciento) presentaron un síndrome de retención gaseosa. Conclusión. La cirugía antirreflujo por vía laparoscópica ofrece resultados similares a los de la cirugía abierta, con las ventajas añadidas de este tipo de abordaje. Estos resultados dependen de una correcta indicación y de la elección de una técnica quirúrgica adecuada e individualizada para cada paciente (AU)

Portal hypertensive colopathy: histologic appearance of the colonic mucosa.

BACKGROUND/AIMS: The aim of this study was to evaluate macroscopic and histologic disorders of the colon in rats with portal hypertension. METHODOLOGY: The animals were divided into two groups: 10 rats in the experimental group and 10 controls. Portal hypertension was induced by a partial ligation of the portal vein. We assessed the histologic appearance and macroscopic alterations of the colonic mucosa 12 weeks after the induction of portal hypertension. RESULTS: The macroscopic results showed the presence of the typical signs of portal hypertension, with dilatation and tortuosity of the mesenteric veins and hyperemia of the rectum and colon. Histologic study revealed a marked dilatation in the microcirculation at the level of the ascending colon (20 +/- 2 micra in diameter) and rectum (30 +/- 4), with a tendency to group the lesions. Submucosal edema without inflammatory signs was observed. CONCLUSION: The existence of these lesions in the colon and rectum can be the cause of hemorrhage, as in the gastropathy of portal hypertension and should be considered in cases of undiagnosed hemorrhage in patients with portal hypertension.

Variations in plasma amino acids in septic patients subjected to parenteral nutrition with a high proportion of branched-chain amino acids.

Sepsis is characterized by an increase in the plasma concentration of aromatic amino acids (AAAs) and those containing sulfur and a decrease in the branched-chain amino acids (BCAAs). We studied changes in the plasma aminogram of septic patients given different types of total parenteral nutrition (TPN), analyzing variations in accordance with the type of TPN used and the importance that the use of BCAA may have in these patients. We studied 80 patients with peritonitis divided into two groups of 40 patients each: group 1 was given a solution with 22.5% BCAA and group 2 a solution with 45% BCAA. High BCAA content caused an increase in the plasma concentrations of these amino acids and in the BCAA/AAA quotient and a decrease in AAAs. Plasma concentrations of leucine and valine reached high, potentially toxic levels at 15 days when solutions with high BCAA content were used. Glycine increased in group 1, which may be important because of its tendency to produce hyperammonemia. BCAAs are of unquestioned nutritional importance in view of the evidence of changes that take place in muscle protein catabolism and in plasma amino acids. In the phase of increased protein catabolism, we saw a plasma amino acid pattern in keeping with the existing metabolic situation. The need for BCAA diminishes when the hypercatabolic state disappears.

[Dieulafoy's vascular disease]. / Enfermedad vascular de Dieulafoy.

Four cases are reported of upper gastrointestinal hemorrhage caused by Dieulafoy's vascular disease treated in our service over the last 15 years. In all these patients bleeding was from an unusually long artery with a tortuous trajectory through the gastric submucosa that eroded the mucosa and caused blood loss. In 75% of the cases it was located 6 cm below the gastroesophageal junction, near the small curvature. The diagnosis is usually made by endoscopy or during emergency gastrostomy. The most effective therapeutic measure is surgical resection.