Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years.

INTRODUCTION AND AIMS: Esophageal perforation is an uncommon event that is a medical/surgical emergency, with a 15-30% mortality rate. The aim of the present study was to communicate our experience in the management of esophageal perforation, evaluating the different strategies utilized, in an effort to establish measures to guide decision-making in selecting treatment. MATERIALS AND METHODS: A retrospective descriptive study was conducted on patients diagnosed with esophageal perforation at our hospital center, within the time frame of 2000 and 2019. RESULTS: Over the past 19 years, 15 patients were diagnosed with esophageal perforation. Surgical treatment was carried out in 80% of the cases. Primary closure, reinforced with plasty, was performed in 67% of the patients, of whom 62.5% had early diagnosis and a 100% survival rate. Diagnosis was late in 37.5% of the cases, with a 33.3% survival rate. Esophagectomy and gastric pull-up were performed on 25% of the patients, 66.6% of whom had early diagnosis and a 100% survival rate. In the 33.3% that had late diagnosis, the mortality rate was 100%. Esophagectomy, with cervical esophagostomy and feeding jejunostomy, was performed on one of the patients (8.3%) that had early diagnosis and a 100% survival rate. CONCLUSIONS: The main survival predictor in esophageal perforation is the interval of time between the injury and its diagnosis, and in turn, the resulting treatment. Each patient with esophageal perforation should have individualized treatment to adequately manage the condition.

Evaluación de las nuevas técnicas quirúrgicas para tratar la incontinencia urinaria femenina / Evaluation of the new surgical techniques in the treatment of female urinary incontinence

Objetivo: Evaluar la eficacia y seguridad de distintas técnicas quirúrgicas con bandas para la IUF, realizadas entre febrero de 2000 y junio de 2004, así como el grado de satisfacción de las pacientes operadas en nuestro servicio. Material y métodos: Se ha realizado un estudio transversal, retrospectivo, analizando distintas variables en las 77 pacientes con IUF que fueron intervenidas en el Servicio de Obstetricia y Ginecología del Hospital General Universitario de Alicante. La evaluación objetiva (eficacia y efectos adversos) se obtuvo al revisar los controles realizados a los 2 y 6 meses y anualmente, teniendo en cuenta la exploración vaginal, las maniobras de Valsalva, el Q-test, el diario miccional, la valoración de síntomas hecha por la paciente e incluso la urodinámica, si se precisó. La evaluación subjetiva se realizó mediante una encuesta telefónica siguiendo el esquema de cuestionarios ya validados. Resultados: De las 77 pacientes, sólo en 60 (77,92%) pudieron valorarse los resultados objetivos en su historia clínica. Objetivamente se consideraron continentes al 59,74% (46/77) o el 76,66% (46/60) si no se contabilizan las no controladas. Subjetivamente, sólo contestaron 65 (84,41 %) pacientes, cuyas respuestas de «satisfacción» se situaron entre el 72,72% y el 86,14% (al excluir las que no respondieron). Las complicaciones fueron similares a otros grupos. Fue difícil establecer un análisis comparativo, ya que los criterios de seguimiento y evaluación son muy distin tos y apenas incluyen el componente subjetivo de la paciente, sin tener en consideración la repercusión en la calidad de vida, presentándose muy dispares y poco reproducibles. Conclusiones: Las intervenciones con bandas son eficaces y seguras, si bien la conclusión de su grado de recomendación debe deducirse de trabajos a largo plazo y donde se incluyan parámetros de calidad de vida en el seguimiento de la paciente. La introducción de nuevas técnicas quirúrgicas debe estar precedida por ensayos controlados y aleatorizados que muestren los resultados objetivos y subjetivos de éstas (AU)

Objective: Evaluation of the efficiency and safety of different surgical techniques with bands for urinary incontinence (VI) in the period February 2000-June 2004, and also the patient satisfaction post-operatively. Material and methods: We made a retrospective transversal study, analyzing different variables in 77 patients with UI who had surgery in the Obstetric and Gynaecology Department of the G.U. Hospital in Alicante. Objective evaluation (efficacy and adverse effects) was obtained on checking the follow up at 2 months, 6 months and annually. This consisted of vaginal examination, Val salva manoeuvre, Q-test, mictional diary, patient self evaluation of symptoms and urodynamics if necessary. Subjective evaluation was made by telephone with the questionnaire already in use. Results: Objective results could be valued in only 60 of the 77 patients (77.92%). We considered 59.74% to be objectively continent (46/77) or 76.66% (46/60) if we don't count those who were not controlled. Subjectively, only 65 patients (84.41 %) replied, their "satisfaction was between 72.72% and 86.14% (excluding those who did not reply). Complications were similar to other groups. It was difficult to establish a comparative analysis since criteria of followup and evaluation are very different. Normally they do not include a subjective component of the patient without taking into consideration her quality of life. They are disparate and reproducing them is of little value. Conclusions: The surgery with bands is effective and safe although its recommendation needs long term studies where the quality of life should be included. The introduction of new surgical techniques must be preceded by controlled and randomized studies including not only the objective but also the subjective results (AU)

[Intravascular lymphomatosis manifesting in the lung]. / Linfomatosis intravascular de presentación pulmonar.

A case of intravascular lymphomatosis with predominant symptoms in the lung (cough and interstitial pulmonary infiltrates) is presented. Fever and confusion were lateness symptoms. Examination postmortem established the diagnosis. In the lung alveolar walls, small arterioles and the capillaries were occupied by atypical cells positives for CD45 and CD20, leukocyte and pan-B markers, and negatives for CD45-Ro and CD34, pan-T and endothelial markers. The main characteristics and the lung participation of this entity were reviewed.

Dosimetric and radiation protection considerations based on some cases of patient skin injuries in interventional cardiology.

Recently, several cases of skin injuries have been detected in patients undergoing cardiac radiofrequency catheter ablation. These procedures were performed on a biplane X-ray system used in a large Spanish hospital for interventional cardiology procedures. Interventional procedures performed and radiation lesions produced on patients are described. The radiation lesions were mainly erythematous lesions and chronic radiodermatitis. Results of the dosimetric evaluations and an analysis of the operational aspects of radiological protection are discussed. Poor image quality could have influenced the length of the procedures. Dose rate at the image intensifier entrance was within usual reported values in literature. However, the focus-to-skin distance for the horizontal X-ray beam was too short, resulting in a high skin dose rate. Additionally, X-ray beams are of fixed orientation, and accumulated skin dose in the patient's right side has been estimated as 11-15 Gy per procedure. In conclusion, practical radiation protection considerations to avoid further incidents of this sort are proposed, concerning the use of X-ray systems specially designed for interventional radiology, the improvement of cardiologists' training in radiation protection and routine patient dose measurements for complex interventional procedures.