Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

BACKGROUND: The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. METHODS: From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. RESULTS: In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. CONCLUSIONS: The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study.

PURPOSE: Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. METHODS: A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. RESULTS: One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. CONCLUSIONS: The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

Síndromes neurológicos asociados al uso de medicamentos. Frecuencia y caracterización / Neurological syndromes associated with drug use. Frequency and characterisation

Introducción: La necesidad de una asistencia sanitaria segura en la que los cuidados y tratamientos no supongan daños diferentes a los derivados de la enfermedad de base, ha motivado este estudio. Nuestro objetivo ha sido determinar la frecuencia y describir los síndromes neurológicos atribuibles a fármacos, su evitabilidad y los niveles asistenciales implicados. Métodos: Estudio observacional. Cohorte prospectiva de todos los sujetos derivados desde atención primaria y especializada, en el período de diciembre de 2008 a enero de 2010, por síntomas neurológicos atribuibles a fármacos y enfermos neurológicos conocidos con clínica distinta o agravada de la enfermedad de base causada por fármacos. Las notificaciones quedaron reflejadas en un cuestionario. Se realizaron distribuciones de frecuencias, medidas de tendencia central, pruebas de la 2 o Fisher y pruebas no paramétricas correspondientes. Resultados: La prevalencia de efectos adversos neurológicos respecto a la muestra total fue 0,586%. De los 105 pacientes seleccionados, los principales efectos adversos fueron: 25,7% síndrome rígido-acinético; 18,1% discinético; 11,4% síntomas neuropsiquiátricos, y 10,5% síndrome confusional. Los grupos farmacológicos más registrados fueron, en orden decreciente: antiepilépticos, dopaminérgicos, antidepresivos, neurolépticos, antivertiginosos y procinéticos. Describimos la población más susceptible y las asociaciones estadísticamente significativas entre la presencia de determinados grupos farmacológicos y síndromes neurológicos concretos.Conclusiones: La baja prevalencia detectada puede deberse al diseño del estudio, aunque los efectos adversos neurológicos suponen el 2,84% de los ingresos en una unidad de neurología.Conocer la epidemiología permitirá identificar los abordajes más seguros, aplicarlos correctamente a la población de mayor riesgo y reducir necesidades asistenciales y recursos médicos (AU)

Introduction: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, hasled to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. Methods: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X2 or Fisher tests and non-parametric tests were performed. Results: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. Conclusions: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources (AU)

Neurological syndromes associated with drug use. Frequency and characterisation.

INTRODUCTION: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, has led to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. METHODS: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X(2) or Fisher tests and non-parametric tests were performed. RESULTS: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. CONCLUSIONS: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources.

Normal values in ambulatory oesophageal pH monitoring at two levels in Spain.

AIM: Upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification. METHODS: 155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS. RESULTS: 130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases. CONCLUSION: This is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

Vasculitis silviana aislada como presentación de una endocarditis bacteriana subaguda / Isolated Sylvian vasculitis as presentation of a subacute bacterial endocarditis

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[Liver injury induced by "natural remedies": an analysis of cases submitted to the Spanish Liver Toxicity Registry]. / Hepatotoxicidad secundaria a "productos naturales": análisis de los casos notificados al Reigstro Español de Hepatotoxicidad.

BACKGROUND: toxic liver damage associated with the use of natural remedies is a growing health problem. OBJECTIVES: to analyze the demographics, and clinical and epidemiological characteristics of patients developing liver injury related to these remedies. PATIENTS AND METHODS: all DILI cases associated with the use of herbal remedies (HR) or dietary supplements (DS) submitted to the Spanish Registry were analyzed. Type of liver damage, severity, and outcome were specifically evaluated. RESULTS: thirteen cases out of 521 DILI cases (2%) submitted to the Spanish Liver Toxicity Registry between 1994 and 2006 were related to HR/DS, which ranked as the 10th therapeutic group with a greater number of cases and above pain killers, anxiolytics, and antipsychotic drugs. Nine patients (69%) were female (mean age 45 years). Nine cases (69%) had jaundice at presentation. The predominating type of liver damage was hepatocellular (12; 92%), and 31% of cases exhibited the common features of hypersensitivity. Camellia sinensis (3, 23%) was the main causative herb, followed by Rhamnus purshianus and isoflavones (Fitosoja(R), Biosoja(R)) (2 cases each, 15%). Three cases (23%) were rechallenged with the offending product. CONCLUSIONS: the incidence of hepatic damage related to HR/DS is not so rare, the most common profile of affected patients being a woman with acute hepatocellular hepatitis. Low suspicion regarding the putative role of herbs in hepatotoxicity makes diagnosis more difficult, and probably increases the incidence of inadvertent rechallenge in these patients.

Peritonitis bacteriana espontánea por Listeria monocytogenes en paciente con cirrosis hepática / Spontaneous bacterial peritonitis by Listeria monocytogenes in a patient with liver cirrhosis

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Role of lamivudine in the reactivation of hepatitis B virus infection in immunodepressed patients.

INTRODUCTION: hepatitis B virus (HBV) reactivation in immunocompromised states is a well-known event that may be a serious problem in endemic areas of infection. Presently, the investigation of hepatitis B status has been recommended prior to receiving cytotoxic treatment. Lamivudine has been used in the reactivation of HBV in immunocompromised states. We report our corresponding data for lamivudine in the treatment of HBV reactivation after intensive chemotherapy in patients with lymphoma and after kidney transplantation. CLINICAL OBSERVATION: we present two cases of HBV reactivation after chemotherapy for lymphoma and two cases after cadaveric renal transplantation treated with lamivudine (100-150 mg/day). RESULTS: we observed a prompt clinical improvement in all patients after lamivudine treatment. Furthermore, laboratory data showed a rapid biochemical and antiviral response. However, the response in lymphoma patients was quicker than in patients who had post-transplantation reactivation of HBV. Therapy was well tolerated and no relevant side effects appeared during follow-up (twenty four months). The HBV remained negative in three cases. CONCLUSION: lamivudine is effective and safe in the treatment of HBV reactivation in immunodepressed patients. Lamivudine therapy should be considered for the treatment of HBV reactivation in patients with prior hepatitis B or chronic hepatitis B with inactive viral replication.

[From the laboratory to the clinic: CFTR and the therapeutic options for cystic fibrosis]. / Del laboratorio a la clínica: CFTR y opciones terapéuticas para la fibrosis quística.

Cystic fibrosis is a common lethal heritable disorder, caused by a defect in a chloride channel protein, namely CFTR. After the identification of the gene and its product by positional cloning (on chromosome 7), CFTR has been characterized as a low conductance (8-10 pSiemens) linear chloride channel, which appears to regulate other apical transport proteins. Two therapeutic options are reviewed: gene transfection and drug therapy. So far, clinical studies have shown that gene transfection cannot effectively restore CFTR function. Simultaneously, several drugs including genistein, phenylimidazothiazoles and gentamicin have been found to activate mutant CFTR, thus, being suitable for single or combined (with gene transfection) treatment.

[Study of the work climate in four critical care units in a hospital]. / Estudio del clima laboral en cuatro unidades de críticos de un hospital.

A study was made of the work climate, which was understood to be the overall group of factors that influence nursing professionals in critical-care units. A descriptive study was made by carrying out an anonymous survey among the staff of four adult critical-care units: intensive care unit, coronary unit, reanimation unit, and cardiac postoperative care unit. The survey included seven factors: occupational satisfaction, occupational stress, occupational pressures, work relations, professional skills, professional training, and sociodemographic variables. Of 132 questionnaires completed, 80% of the persons who answered accepted their tasks, but only 51% indicated that they planned to continue in the critical-care unit. Sixty percent of the persons surveyed indicated that their work was stressful and that they felt physically fatigued as the workday progressed. Similarly, 60% reported that their work sometimes had a negative impact on family life and 35% indicated that it affected their health. Relations among members of the health-care team were reported as good by 90%. Seventy-five percent were capable of working independently and resolving situations at their own initiative. Ninety-five percent of the persons who completed the survey considered the possibilities for professional advancement to be scant and 88% were interested in the development of specialization. It was interesting that one third of the persons in the sample wanted to leave the hospital. Unit ergonomics had a negative effect on work activities. Staff felt a lack of information in spite of good relations with superiors and other team members. They felt the need for more social and professional recognition, as well as better economic remuneration, but they expected specialization to palliate these needs to some degree.

[Juvenile polyposis in 2 patients of the same family]. / Poliposis juvenil en dos pacientes de una misma familia.

Two cases of juvenile familiar polyposis (one 40-year-old male and his 14-year-old daughter) are presented. The girl presented intermittent rectal bleeding since the age of 10 with growth retardation and chronic anemia. The child was treated by colectomy with more than 100 juvenile polyps without adenomatous alterations being observed in the surgical specimen. Juvenile gastric polyps were also endoscopically observed. The father underwent sigmoidectomy for a adenomatous polyp of this localization. Later review of the surgical specimen demonstrated a juvenile polyp with zones of adenomatous alterations. The diagnostic difficulties of this rare entity and the therapeutic options available are discussed.

[Percutaneous cholecystostomy guided by ultrasonography. A preliminary experience]. / Colecistostomía percutánea guiada por ecografía. Experiencia inicial.

Surgical cholecystostomy is a palliative treatment for cholecystitis and distal biliary obstructions when the general condition of the patient does not allow complex techniques. Percutaneous cholecystostomy (PC) guided by ultrasonography is an alternative to that procedure as well as a method of direct access to the biliary tract for diagnostic examinations (bacteriologic study of bile and percutaneous cholangiography). During one year, 9 female patients, mean age 74 (49 to 90) underwent this approach; 5 patients had cholecystitis, 2 were suspicious of biliary sepsis and 2 had angiocholitis. Because of poor general condition, no other approach was possible in any of the cases. There were no relevant complications. All 5 cases of cholecystitis improved after the procedure although 3 patients died within 30 days of causes unrelated to PC. In two cases biliary sepsis was ruled, and the probe was withdrawn, without complications. The two patients with angiocholitis improved significantly; in both cases it was shown that the cause was cholelithiasis: later on, they were treated by different methods (endoscopic sphincterotomy in one case and surgery in the third case). These preliminary results suggest that PC guided by echography should be included as a routine therapeutic and diagnostic method in the management of digestive diseases.

[Anomaly of the biliopancreatic junction, choledocal cyst and pancreatic lithiasis. Endoscopic possibilities]. / Anomalía de la unión biliopancreática, quiste coledociano y litiasis pancreática. Posibilidades endoscópicas.

Choledocus cyst is a rare anomaly which affects the intramural segment of the common bile duct. The presenting clinical symptoms are recurrent abdominal pain, episodes of jaundice, with fever, and increased levels of serum amylase. Although the diagnosis may be obtained by conventional clinical and radiologic methods, the anatomy of the ducts is best demonstrated by endoscopic retrograde cholangiopancreatography; moreover, this technique enables some therapeutic manoeuvres. We present a young girl with a choledocus cyst and some other ductal abnormalities with the results of the previously mentioned technique.

[Pulmonary disease during mtx therapy in a.l.l. (author's transl)]. / Complicaciones pulmonares del tratamiento con metotrexate en la leucemia linfoblástica aguda

Authors describe three cases of pulmonary disease showed in three children with acute lymphoblastic leukemia during maintenance therapy with Methotrexate (MTX) (Dose: 30 mg/sm/W). The initial symptom occurs in the lapse between 40 and 135 days within the first MTX maintenance period and in 35 days in the second maintenance period. Leukopenia with eosinophilia (192-264 eosinophils/mm3) occurs in case 1. The maintenance of the MTX therapy in this case ends with death of the patient. Radiological studies show basal bilateral pulmonary infiltrations, with pleural involvement in one case. Authors insist in the drug (MTX) suppression as main therapy and agree with the opinion of some authors concerning to the 31 cases previously published.