Adrenalectomía bilateral laparoscópica por feocromocitoma en el síndrome de Von Hippel Lindau: técnica con 4 trocares / Bilateral Laparoscopic adrenalectomy due to a phaeochromocytoma in Von Hippel-Lindau Syndrome: a technique with 4 trocars

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Factores predictores de mortalidad en la colitis isquémica grave: análisis de 101 pacientes intervenidos / Predictive factors of mortality in severe ischaemic colitis: post-operative analysis of 101 patients

Introducción La colitis isquémica (CI) es la forma más frecuente de enfermedad isquémica digestiva y está infradiagnosticada. Objetivos Describir los resultados obtenidos en pacientes con CI que necesitaron de intervención quirúrgica en nuestro centro, y evaluar los factores predictores de mortalidad. Métodos Los datos fueron obtenidos de la base de CI del Hospital Gregorio Marañón. Las características demográficas, clínicas, los métodos diagnósticos, las técnicas quirúrgicas empleadas y la mortalidad fueron analizados estadísticamente empleando la prueba de la χ2 y la t de Student. Resultados Entre 1991 y 2006, se operó a 101 pacientes con CI. La mayoría de éstos tenían antecedentes cardiovasculares y 35 casos fueron diagnosticados durante su ingreso hospitalario por otra causa. Tanto los signos como los síntomas fueron inespecíficos en el 40% de los casos. La morbilidad y la mortalidad total fue del 39,6 y el 41,6%, respectivamente. En los casos de CI postoperatoria, la mortalidad se elevó hasta el 68% (p<0,01); el 93% de los paciente que fallecieron tenían necrosis transmural durante la cirugía (p<0,05) y el 69% tenía acidosis metabólica. Conclusiones La mortalidad en pacientes afectos de CI que necesitan intervención quirúrgica es alta, especialmente si el diagnóstico se hace en el postoperatorio de otra cirugía o si se evidencia necrosis transmural durante la intervención. Para mejorar estos resultados el diagnóstico precoz es la mejor arma, y debe basarse en un alto índice de sospecha(AU)

IntroductionIschaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed. Objectives To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality. Methods The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the χ2 and Student t test. Results One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis. Conclusions The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results (AU)

[Predictive factors of mortality in severe ischaemic colitis: post-operative analysis of 101 patients]. / Factores predictores de mortalidad en la colitis isquémica grave: análisis de 101 pacientes intervenidos.

INTRODUCTION: Ischaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed. OBJECTIVES: To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality. METHODS: The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the chi(2) and Student t test. RESULTS: One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis. CONCLUSIONS: The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results.

[Safety and efficiency of ambulatory treatment of acute diverticulitis]. / Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda.

INTRODUCTION: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management. OBJECTIVE: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients. METHODS: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month. RESULTS: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery. CONCLUSIONS: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs.

Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda / Safety and efficiency of ambulatory treatment of acute diverticulitis

Introducción: el tratamiento de la diverticulitis aguda está siendo recientemente revisado y muestra una tendencia a limitar el tratamiento quirúrgico y potenciar el de tipo conservador.Objetivo: analizar la eficiencia y la seguridad del tratamiento ambulatorio de la diverticulitis aguda en un grupo seleccionado de pacientes.Métodos: estudio prospectivo sobre el tratamiento antibiótico oral domiciliario de la diverticulitis aguda en una cohorte de pacientes, realizado en la sección de cirugía de urgencias de nuestro centro.Pacientes y tratamiento: 74 pacientes (44 varones y 30 mujeres) fueron incluidos en el período 2000–2006; se seleccionaron los tipo I de Hinchey y los tipo II con absceso menor de 3cm, clínica y analíticamente estables, y se trataron con ciprofloxacino y metronidazol, por vía oral, durante 7–10 días. El seguimiento se realizó en consultas externas mediante control clínico a los 10 días y prueba de imagen al cabo de un mes.Resultados: la edad media era de 55 años. La presentación clínica más frecuente fue dolor abdominal espontáneo asociado a leucocitosis. La duración media del tratamiento fue de 8,8 días. Cuatro pacientes (5,4%) precisaron ingreso posterior para tratamiento antibiótico intravenoso y 70 (94,6%) completaron el tratamiento sin complicaciones. Durante el seguimiento diagnosticamos 2 casos de adenocarcinoma de colon y 6 de poliposis. Solamente 13 pacientes recibieron cirugía electiva.Conclusiones: el manejo conservador ambulatorio ha demostrado ser seguro y eficaz en el tratamiento de la diverticulitis aguda no complicada en la mayoría de los pacientes de nuestro estudio, consiguiendo además una reducción de la estancia hospitalaria y una minimización de los costes(AU)

Introduction: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management.Objective: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients.Methods: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7–10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month.Results: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery.Conclusions: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs(AU)