Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica / Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique

Introducción y objetivo: El abordaje mediante cirugía mínimamente invasiva de la patología de la glándula suprarrenal es el más extendido hoy en día, en donde la retroperitoneoscopia ocupa un lugar a tener muy en cuenta; sin embargo, la evolución de estas técnicas hacia abordajes todavía menos invasivos a través de puerto único es anecdótica.La finalidad de este trabajo es describir nuestra experiencia inicial en cirugía retroperitoneoscópica por puerto único (SPORS) de la glándula suprarrenal centrándonos en los datos perioperatorios y dolor postoperatorio.Material y métodosRecogimos y analizamos los datos demográficos y operatorios de una serie de pacientes tratados mediante suprarrenalectomía mediante SPORS. Todos los procedimientos se realizaron mediante una única incisión subcostal de 3-4cm a través de un puerto multicanal. Se recogen diferentes datos quirúrgicos como tiempo operatorio, sangrado, estancia o presencia de complicaciones. Empleamos la escala visual analógica (EVA) para la valoración del dolor postoperatorio.ResultadosEntre diciembre del 2018 y agosto del 2020, 6 pacientes con diferentes patologías suprarrenales fueron intervenidos en nuestro Departamento de forma consecutiva por el mismo cirujano mediante SPORS. Todas las cirugías se realizaron sin requerir colocación de trocares accesorios o reconversión a cirugía abierta. El tiempo medio de las intervenciones fue de 91,6±16,3 min, con un sangrado <150ml, una estancia media de 35,8±13,3 h y un dolor postoperatorio analizado EVA ≤ 3 (mediana de 0,5). El tamaño medio de las piezas fue de 57,8±18mm. No se reportó ninguna complicación según la escala Clavien-Dindo.

Introduction and objective: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain.Material and methodsWe collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment.ResultsFrom December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. (AU)

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ±â€¯16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ±â€¯13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ±â€¯18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. / Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Neospora caninum antibodies in wild carnivores from Spain.

Serum samples from 251 wild carnivores from different regions of Spain were tested for antibodies to Neospora caninum by the commercial competitive screening enzyme linked immunosorbent assay (c-ELISA) and confirmed by Neospora agglutination test (NAT) and/or by indirect fluorescent antibody test (IFAT). Samples with antibodies detected by at least two serological tests were considered seropositive. Antibodies to N. caninum were found in 3.2% of 95 red foxes (Vulpes vulpes); in 21.4% of 28 wolves (Canis lupus); in 12.0% of 25 Iberian lynx (Lynx pardinus); in 16.7% of 6 European wildcats (Felis silvestris); in 6.4% of 31 Eurasian badgers (Meles meles); in 21.4% of 14 stone martens (Martes foina); in 66.7% of 3 pine martens (M. martes) and in 50% of 2 polecats (Mustela putorius). Antibodies to N. caninum in common genets (Genetta genetta) and Egyptian mongooses (Herpestes ichneumon) were only observed by c-ELISA but were not confirmed by IFAT and/or NAT. No antibodies were detected in 5 Eurasian otters (Lutra lutra) by any technique. Statistically significant differences were observed among species and among geographical areas. The highest seroprevalence of N. caninum infection was observed in the Cantabric Coastal region characterized by high humidity. To our knowledge, this is the first report of antibodies to N. caninum in free ranging wild carnivores, other than wild canids, in Europe. The existence of a possible sylvatic cycle could have important implications in both sylvatic and domestic cycles since they might influence the prevalence of infection in cattle farms in those areas.

Characterization of widespread canine leishmaniasis among wild carnivores from Spain.

Visceral Leishmaniasis (VL) is an emerging zoonotic parasitic disease caused by Leishmania infantum in Mediterranean countries, with sand flies (Phlebotomus spp.) as vectors and dogs as the main domestic reservoir. The role of wild carnivores in the epidemiology of leishmaniasis is still controversial. In order to determine the prevalence of natural infection with L. infantum in wild carnivores from Spain, we analyzed 217 samples by PCR and western blotting and used restriction fragment length polymorphism (RFLP) to compare the patterns present in wild carnivores with those of domestic dogs from the same areas. DNA of the parasite was detected in spleen or blood samples from 35 (16.12%) analyzed wild carnivores, including 8 of 39 (20.5%) wolves (Canis lupus), 23 of 162 (14.1%) foxes (Vulpes vulpes), 2 of 7 (28.6%) Egyptian mongooses (Herpestes ichneumon), 1 of 4 genets (Geneta geneta), and 1 of 4 Iberian lynxes (Lynx pardinus). No significant sex or age differences in prevalence were observed in wolves and foxes (P>0.05), but there was a significant difference among regions in foxes (P<0.05). A total of 12 PCR-RFLP patterns were found in foxes, 6 in wolves, 4 in dogs, 2 in Egyptian mongooses and 1 in lynx and genet. RFLP patterns differed between dogs and foxes in the two areas where they could be compared. This is the first study of canine leishmaniasis in wild canids and other carnivores from different regions of Spain by PCR. The prevalence of infection indicates the existence of natural infection in apparently healthy wild carnivore populations, and our results are suggestive of a sylvatic cycle independent of dogs.

Prevalence of antibodies against canine distemper virus and canine parvovirus among foxes and wolves from Spain.

Viral diseases can influence the population dynamics of wild carnivores and can have effects on carnivore conservation. Hence, a serologic survey was conducted in an opportunistic sample of 137 foxes (Vulpes vulpes) and 37 wolves (Canis lupus) in Spain for 1997-2007 to detect antibodies against canine distemper virus (CDV) and against canine parvovirus (CPV) by indirect ELISA. Antibodies against CDV were detected in 18.7% of the analyzed animals and antibodies against CPV in 17.2%. There was no difference in antibody prevalence to CDV between both species, even in the same region (P>0.05), but there was a significant difference in antibody prevalence to CPV between foxes (5.1%) and wolves (62.2%) (P<0.05). In fox populations there was a significant difference in antibody prevalence to CDV between geographic areas (Aragón 26.4%, La Mancha 7.8%, P<0.05). In wolf populations there was significantly higher antibody prevalence against CPV (P<0.05) in Castilla y León (100%) than in the Cantabric region (53.3%). There was no significant sex or age-related difference in the antibody prevalence against CDV or CPV in foxes. These results indicate that contact with CDV is widespread among wild canid populations in Spain and that CPV is endemic in the Iberian wolf population. The implications of these results are briefly discussed.

Seroprevalence of Toxoplasma gondii antibodies in wild carnivores from Spain.

Serum samples from 282 wild carnivores from different regions of Spain were tested for antibodies to Toxoplasma gondii by the modified agglutination test using a cut-off value of 1:25. Antibodies to T. gondii were found in 22 of 27 (81.5%) of Iberian lynx (Lynx pardinus), 3 of 6 European wildcats (Felis silvestris), 66 of 102 (64.7%) red foxes (Vulpes vulpes), 15 of 32 (46.9%) wolves (Canis lupus), 26 of 37 (70.3%) Eurasian badgers (Meles meles), 17 of 20 (85.0%) stone martens (Martes foina), 4 of 4 pine martens (Martes martes), 6 of 6 Eurasian otters (Lutra lutra), 4 of 4 polecats (Mustela putorius), 1 of 1 ferret (Mustela putorius furo), 13 of 21 (61.9%) European genets (Genetta genetta), and 13 of 22 (59.1%) Egyptian mongooses (Herpestes ichneumon). Serological results indicated a widespread exposure to T. gondii among wild carnivores in Spain. The high T. gondii seroprevalence in Iberian lynx and the European wildcat reported here may be of epidemiologic significance because seropositive cats might have shed oocysts.

Echinococcus granulosus (Cestoda, Taeniidae) in the Iberian wolf.

The intestinal contents of 27 Iberian wolves (Canis lupus signatus) from Spain were screened for the presence of the taenid cestode Echinococcus granulosus. Four animals were found positive (15% prevalence). The intensity of parasitation was variable (mean 71, range 1-147 E. granulosus per host). Gravid individuals were found in all wolves positive with the parasite. Molecular characterization of the parasite material showed that the wolf strain belongs to the G1 genotype. According to the results, we conclude that the Iberian wolf takes part in the maintenance of the life cycle of this zoonotic parasite in Spain and that this fact could have public health relevance.

Hernia de Bochdalek de presentación tardía asociada a enfermedad de Hirschsprung / Delayed presentation of Bochdalek hernia associated with Hirschsprung disease

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[Periodical EEG pattern modifications in herpetic encephalitis treated with acyclovir]. / Modificaciones del patrón EEG periódico en las encefalitis herpéticas tratadas con aciclovir.

The presence of PLED or localized or lateralized periodic activity in encephalitis strongly suggests that the encephalitis is due to the herpes simplex virus. Nevertheless, there has been controversy over its clinical significance. In addition, since the introduction of antiviral drugs in the treatment of herpes encephalitis in its initial stages, the prognosis of the disease has improved. We studied nine patients all diagnosed as having herpes encephalitis and treated with acyclovir. The presence or absence of periodic activity and its characteristics were analyzed. It was seen that either there was no such activity, or if there was, it was not exactly as classically described.

[Sleep disorders and Parkinson disease: study of a series]. / Trastornos del sueño y enfermedad de Parkinson: estudio de una casuística.

Disturbances of sleep are frequent and varied in patients with Parkinson's disease. In an attempt to find out about these disturbances, we carried out interviews using the Vanna and Mazzuia questionnaire, modified for forty-five sufferers of Parkinson's disease, and forty healthy adults. We researched sleep habits and disturbances, as well as the consumption of hypnotics. We found that both groups had similar habits, although those with PD altered according to the stage of development of the disease, thus difficulty in staying sleep and parasomnia were more frequent in PD sufferers and worsened in the most advanced cases. On the other hand the quality of night sleep and the consumption of hypnotics interfered in the daytime efficiency of those suffering from Parkinson's Disease.

[Appendicular carcinoid tumor in childhood]. / Tumor carcinoide apendicular en la infancia.

Apendicular Carcinoid tumors are very infrequent, being lower than 0.1% of the appendicectomies carried out. We report on the case of a 13 year-old girl, with Acute Appendicitis picture. The appendix was removed and the histological study revealed the presence of the carcinoid tumor with a diameter of a 6 mm. Where non-invasive treatment was decided on, and at present, after two years follow-up, there has been no recurrence.

[Psychologic iatrogenic disease in the postsurgical child]. / Iatrogenia psicológica en el niño postquirúrgico.

In the present paper, we comment on the psychological and emotional disorders occurring after surgery. We surveyed 150 children that were admitted in several surgical units of our Children's Hospital. We used the Vernon's test in a questionaire. We reached a high level of comprehension. As a result, 121 valid questionaires were returned. The considerable amount of information was statistically studied with a computer, obtaining data on the following aspects: Filiation, frequency and percentage of every answer. Post-hospitalization behaviour evaluated by Vernon's test. Partial and total results under the 6 factors of the questionaire: General anxiety and regression, anxiety about separation, anxiety about sleeping, eating disturbances, agressiveness against authority, apathy and isolation. Previous results in connection with the diverse filiation variables. When we analyzed the results, we confirmed the findings of other investigators: A global damage in child behaviour, that is present in two main aspects: "Anxiety about separation" and "Agressiveness against authority". In conclusion, our results support the need for implementing prophylactic measures, of which "psychological presentation" is the most important, to children that are going to be operated upon.

Timing, mechanism and clinical setting of witnessed deaths in postmyocardial infarction patients.

The temporal distribution and mechanism of death were studied in a large multicenter secondary prevention trial (Aspirin Myocardial Infarction Study) in which acute witnessed death represented 72% (270 of 376) of the deaths due to arteriosclerotic heart disease. Instantaneous deaths represented 28.9% (78 of 270) of the acute witnessed deaths; 45.2% (122 of 270) occurred in the first hour after the onset of symptoms and were defined as sudden deaths. In the subsequent 23 hours, an additional 113 deaths (41.8%) occurred and were defined as intermediate deaths; 29 late deaths (10.7%) occurred after 24 hours. Cardiac arrhythmia was the mechanism of death in 83% (194 of 235) of deaths within 24 hours. Univariate analysis of baseline clinical and electrocardiographic characteristics indicates that a history of congestive heart failure, cardiomegaly, angina pectoris, multiple myocardial infarctions and therapy with digitalis and nitroglycerin were more common in those who died than in survivors, regardless of the timing of death.