Training in ambulatory surgery. A pending subject in our country.

The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2 / Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.(AU)

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.(AU)

[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Aportación de la colonoscopia virtual en un caso de invaginación intestinal / Contribution of the virtual colonoscopy in a case of intestinal intussusception

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Contribution of the virtual colonoscopy in a case of intestinal intussusception.

The present paper describes a case of ileocecal intussusception detected by ultrasound and confirmed by CT, including the imaging characteristics allowing its diagnosis. The patient was referred for colonoscopy, which could not be completed, to assess the cause of intussusception. Then it was decided to resort to Virtual colonoscopy, which allowed to identify and characterize a cecal neoplasm serving as a lead point for the intussusception.

Adalimumab vs Azathioprine in the Prevention of Postoperative Crohn's Disease Recurrence. A GETECCU Randomised Trial.

BACKGROUND AND AIMS: Postoperative recurrence of Crohn's disease [POR-CD] is almost certain if no prophylaxis is administered. Evidence for optimal treatment is lacking. Our aim was to compare the efficacy of adalimumab [ADA] and azathioprine [AZA] in this setting. METHODS: We performed a phase 3, 52-week, multicentre, randomised, superiority study [APPRECIA], in which patients with ileocolonic resection were randomised either to ADA 160-80-40 mg subcutaneously [SC] or AZA 2.5 mg/kg/day, both associated with metronidazole. The primary endpoint was endoscopic recurrence at 1 year [Rutgeerts i2b, i3, i4], as evaluated by a blinded central reader. RESULTS: We recruited 91 patients [median age 35.0 years, disease duration 6.0 years, 23.8% smokers, 7.1% previous resections]. The study drugs were administered to 84 patients. Treatment was discontinued owing to adverse events in 11 patients [13.1%]. Discontinuation was significantly less frequent in the ADA [4.4%] than in the AZA group [23.2%] (dif.: 18.6% [95% CI 4.1-33.2], p = 0.011). According to the intention-to-treat analysis, therapy failed in 23/39 patients in the AZA group [59%] and 19/45 patients in the ADA group [42.2%] [p = 0.12]. In the per-protocol analysis [61 patients with centrally evaluable images], recurrence was recorded in 8/24 [33.3%] patients in the AZA and 11/37 [29.7%] in the ADA group [p = 0.76]. No statistically significant differences between the groups were found for recurrence in magnetic resonance images, biological markers of activity, surgical procedures, or hospital admissions. CONCLUSIONS: ADA has not demonstrated a better efficacy than AZA [both associated with metronidazole] for prophylaxis of POR-CD in an unselected population, although tolerance to ADA is significantly better. ClinicalTrials.gov NCT01564823.

Cambios bioquímicos en corredores populares tras correr una maratón (test de estrés) / Biochemical changes in Popular Runners after a marathon (Stress Test)

El estudio que hemos llevado a cabo con un grupo de corredores veteranos, pero con una larga trayectoria en el deporte popular, consiste en analizar los cambios que se producen en los perfiles bioquímicos de un grupo de quince corredores populares que corren una maratón. A este esfuerzo máximo lo hemos denominado «Test de Estrés». Nuestros objetivos se encaminan a evaluar los resultados de los cambios producidos en los par.metros bioquímicos simples en corredores populares para referenciarlos con los que se producen en los atletas profesionales, es un estudio de prevalencia, sin variables previas ni asignación aleatoria. El método empleado: toma de muestra sanguínea previa (condiciones basales ó de referencia) y otra inmediatamente posterior. Los resultados obtenidos: incremento de la concentración de glucemia en sangre del 3,25% incremento de la urea del 95% y de la creatinina del 45,3 mientras sobre el colesterol no tiene repercusión y sobre los triglicéridos el incremento esta en 3%. Discutimos nuestros resultados comparándolos con los resultados publicados sobre los profesionales, con la intención de ver las diferencias en los cambios de los valores bioquímicos en los profesionales frente a los corredores populares, aficionados y veteranos. Hemos encontrado estudios sobre profesionales de otras disciplinas, tales como triatletas, ciclistas, esquiadores etc. La conclusión es que los beneficios y perjuicios de ejercicio físico intenso son tan beneficiosos o perjudiciales para ambos grupos. Pero las diferencias encontradas en los valores bioquímicos sirven para comparar el deporte profesional y aficionado

The study we conducted with a group of veteran runners, but with a long career in the popular sport, is to analyze the changes that occur in biochemical profiles of a group of fifteen amateur runners who run a marathon. This maximum effort we have called «stress tests». Our goals are aimed at evaluating the results of the changes in biochemical parameters in simple popular runners to reference them with those occurring in professional athletes, is a prevalence study without previous variables or random assignment. The method employed: previous blood sampling (baseline or reference conditions) and another immediately after. The results: increased blood glucose concentration of 3.25% increased 95% urea and creatinine of 45.3 while on cholesterol has no effect on triglycerides and the increase was 3%. We discuss our results against the results published on the professionals, with the intent to see the differences in the changes of biochemical values in the pros versus popular riders, amateurs and veterans. We found studies professionals from other disciplines, such as triathletes, cyclists, skiers etc. The conclusion is that the benefits and harms of intense physical exercise are as beneficial or detrimental to both groups. But the differences in biochemical values are used to compare the professional and amateur sport

Bowel ischaemia and cocaine consumption; case study and review of the literature.

BACKGROUND: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. CASE REPORT: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. DISCUSSION: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alkaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients.

Isquemia intestinal y consumo de cocaína; presentación de un caso y revisión de la literatura / Bowel ischaemia and cocaine consumption; case study and review of the literature

Introducción: entre los efectos nocivos del consumo de cocaína se incluyen los producidos a nivel de la vascularización mesentérica, instaurándose en forma de cuadros abdominales isquémicos de potencial gravedad que, si no son diagnosticados y tratados adecuada y precozmente, conllevan complicaciones serias e incluso a la muerte por sepsis. Caso clínico: presentamos el caso de un hombre de 40 años que fue intervenido de urgencias por abdomen agudo secundario a isquemia segmentaria múltiple de asas de delgado y sigmoides. Se realizó resección intestinal y anastomosis. La anatomía patológica del segmento describió hallazgos compatibles con necrosis transmural y flebitis necrotizante producida por el efecto de drogas o tóxicos; el paciente confirmó el consumo previo y habitual de cocaína. Discusión: la difusión entre la población generalmente joven, del consumo de este y de otros tóxicos derivados de los alcaloides de la Erythroyilon coca, ha condicionado un incremento de las consultas en urgencias por dolor abdominal agudo; generalmente, en muchos de estos casos, los pacientes se intervienen quirúrgicamente sin diagnóstico o lo que es más grave, fallecen sin el mismo. Entre los efectos adversos a nivel gastrointestinal de la cocaína y sus derivados, se encuentran la perforación de víscera hueca, la hemorragia digestiva, y los problemas vasculares en forma de enteritis y colitis isquémica. Sería aconsejable un interrogatorio minucioso sobre el consumo de cocaína y otras drogas o la solicitud de su presencia en orina, y la sospecha clínica de una isquemia intestinal no oclusiva originada por cocaína en aquellos adultos jóvenes sin factores de riesgo cardiovascular, sobre todo con vistas a planificar el correcto tratamiento (AU)

Background: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. Case report: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. Discussion: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alcaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients (AU)

Cáncer de mama en varones: casos recogidos en 20 años (1990-2011) / Breast cancer in males and cases observed in 20 years (1990-2011)

Introducción: en la sociedad occidental el cáncer de mama es el de mayor prevalencia en el sexo femenino, pero es muy raro en el sexo masculino (0,1-0,2 por ciento). Tras analizar la epidemiología y los factores de riesgo, se realizó un estudio retrospectivo de los casos hallados en una unidad de unidad de cirugía menor ambulatoria (CmA) del Hospital General de Especialidades Juan Grande en el periodo de 1990 a 2011 (n = 10). Métodos: se describen los hallazgos en la unidad CmA, adonde acuden pacientes con diagnósticos de afecciones benignas, fundamentalmente de piel, anejos cutáneos y tejidos subcutáneos. Se eligió, describió y siguió a los varones que resultaron tener un carcinoma de mama. Los criterios de inclusión fueron el sexo masculino y la confirmación histológica de cáncer de mama. Se estudiaron las variables epidemiológicas, tumorales y terapéuticas, y la supervivencia. Resultados: hubo 10 sujetos con edades de 58 ± 15 años, sin antecedentes de especial interés. Las tumoraciones se localizaban en la cara anterior del tórax, en la región mamaria, de forma unilateral. El 100 por ciento de los pacientes acudieron con diagnóstico de una afección benigna, e igualmente en el 100 por ciento de los casos el diagnóstico anatomopatológico definitivo fue carcinoma ductal. Conclusiones: los pacientes se diagnosticaron después de una cirugía y no hubo diagnóstico clínico previo. La supervivencia estuvo condicionada por la tardanza en el diagnóstico y, por tanto, en el inicio del tratamiento. La supervivencia a los 5 años de revisiones fue de 7 pacientes, aunque algunos fallecieron por otras causas(AU)

Introduction: breast cancer in the Western society has the highest prevalence rate in females, but it is very rare in males (0.1-0.2 percent). After analyzing the epidemiology and the risk factors, a retrospective study was conducted on the cases found in an outpatient minor surgery unit of Juan Grande general hospital of medical specialties in the period of 1990 through 2011 (n= 10). Methods: the findings observed in this unit were described, where patients with benign disease diagnoses fundamentally went because of skin problems, cutaneous adnexes and subcutaneous tissues. The males suffering breast carcinoma were selected, described and followed-up. Inclusion criteria were being male and histological confirmation of breast cancer. The epidemiological, tumoral and therapeutical variables were under study as well as survival rates. Results: there were 10 individuals aged 58 ± 15 years, with no history of special interest. Tumors were located in the anterior side of thorax, unilateral, in the breast region. One hundred percent of patients went to the unit with benign diagnosis and, the final anatomopathological diagnosis of all the cases was ductal carcinoma. Conclusions: the patients were diagnosed after one surgery and there was not previous clinical diagnosis. The survival depended on the time of diagnosis and on the time of beginning the treatment. The survival rate after 5 years of review was 7 patients, although some died from other causes(AU)

The influence of immunosuppression switching in liver function in adult hepatic transplantation.

We evaluate the 5-year results of a single-centre prospective randomized trial that compared cyclosporine microemulsion (CyA-me) in triple therapy (plus steroids and azathioprine) and Tacrolimus (Tac) in double therapy (plus steroids) for primary immunosuppression. One hundred adult patients undergoing liver transplantation were randomized to receive Tac (n=51) or CyA-me (n=49). Ten patients in group A, and thirty-one patients in group B had their main immunosuppressive agent switched. The switch was much more frequent from CyA-me to Tac (n=31; 62.3%), mainly because of lack of efficacy (n=12; 38.7%). Six of 10 patients were shifted from Tac to CyA-me for side effects. The clinical course of the majority of patients converted from CyA-me to Tac improved clearly after conversion. Donor age and acute rejection (number, severity and rejection free days) had a significative association with lack of efficacy in group B. In these series, the conversion to Tac from CyA-me could be accomplished safely, with an excellent long-term outcome.

[Application of new technologies to the teaching of surgery in the school of medicine]. / Aplicación de las nuevas tecnologías en la enseñanza de la cirugía en la licenciatura de medicina.

INTRODUCTION: The new methods of teaching, based on new technologies, already available in other educational and professional fields are gradually being introduced in our Medical Schools. The aim of our study is to present our initial experience in the introduction of a subject on the principles of surgery in our university. MATERIAL AND METHODS: The subject was offered voluntary to undergraduate students, with a maximum of 65 students per course during two consecutive academic years, while maintaining the traditional teaching with a formal lecture program with a different lecturer. The subject was designed with 60% virtuality on a WebCT platform and later in Moodle. The virtual subject was structured into teaching units, academically directed activities and communication tools. The subject was assessed in a report prepared by Cadiz University Department of Evaluation and Quality. RESULTS: There were 32 students in the 2005-2006 course and 62 in the following course. The mean activity of the students was: 602 accesses, 13 subjects for discussion forums and 20 e-mails between students and teachers. The students who participated in the Virtual subject have remarked that virtualisation make it more attractive and is an aid in the acquisition of knowledge. The data obtained from the report showed better results than the mean obtained in other subjects of the Department, School of Medicine and Cadiz University. CONCLUSIONS: The virtual subject of principles of surgery has been well evaluated in our university campus. We believe that the provision of teaching tools and new communication models make an effective contribution to the teaching of surgery as a subject in the school of medicine curriculum.

Aplicación de las nuevas tecnologías en la enseñanza de la cirugía en la licenciatura de medicina / Application of new technologies to the teaching of surgery in the school of medicine

Introducción: Los nuevos métodos de enseñanza, basados en las nuevas tecnologías, ya adoptados en otros ámbitos educativos y profesionales, se van introduciendo progresivamente en las facultades de medicina. El objetivo de nuestro estudio es presentar nuestra experiencia inicial en la implantación de una asignatura de carácter semipresencial de fundamentos de cirugía. Material y métodos: La asignatura se ha ofrecido con carácter voluntario a los estudiantes, y mantiene el grupo de enseñanza tradicional con un profesor responsable distinto. La asignatura se planificó con un porcentaje de virtualidad del 60% en la plataforma virtual WebCT y, posteriormente, en la plataforma Moodle. La asignatura virtual se estructuró en unidades temáticas, actividades académicamente dirigidas y herramientas de comunicación. En la valoración de la asignatura se presentan los informes realizados por la Unidad de Calidad de la Universidad de Cádiz (UCA). Resultados: Se matricularon 32 alumnos en el curso 2005¿2006 y 62 alumnos en el siguiente curso. El promedio de actividad en el aula virtual por alumno fue: 602 accesos, 13 temas de discusión propuestos en los foros y 20 correos intercambiados entre alumnos y profesores. Los alumnos que han cursado la asignatura han señalado que la virtualización de la asignatura la convierte en más atractiva y contribuye a la adquisición de conocimientos. Los datos del informe sobre la docencia han sido mejores que la media del departamento, la facultad de medicina y la UCA. Conclusiones: La asignatura virtual de fundamentos de cirugía ha sido muy bien valorada dentro de nuestro ámbito universitario. Pensamos que las herramientas docentes ofrecidas y los nuevos modelos de comunicación contribuyen eficazmente a la enseñanza de la cirugía como disciplina dentro de la licenciatura de medicina (AU)

Introduction: The new methods of teaching, based on new technologies, already available in other educational and professional fields are gradually being introduced in our Medical Schools. The aim of our study is to present our initial experience in the introduction of a subject on the principles of surgery in our university. Material and methods: The subject was offered voluntary to undergraduate students, with a maximum of 65 students per course during two consecutive academic years, while maintaining the traditional teaching with a formal lecture program with a different lecturer. The subject was designed with 60% virtuality on a WebCT platform and later in Moodle. The virtual subject was structured into teaching units, academically directed activities and communication tools. The subject was assessed in a report prepared by Cadiz University Department of Evaluation and Quality. Results: There were 32 students in the 2005¿2006 course and 62 in the following course. The mean activity of the students was: 602 accesses, 13 subjects for discussion forums and 20 e-mails between students and teachers. The students who participated in the Virtual subject have remarked that virtualisation make it more attractive and is an aid in the acquisition of knowledge. The data obtained from the report showed better results than the mean obtained in other subjects of the Department, School of Medicine and Cadiz University. Conclusions: The virtual subject of principles of surgery has been well evaluated in our university campus. We believe that the provision of teaching tools and new communication models make an effective contribution to the teaching of surgery as a subject in the school of medicine curriculum (AU)

[Retroperitoneal sarcomas. Report of five new cases and review of the current situation]. / Sarcomas retroperitoneales. Aportación de cinco nuevos casos y revisión de la situación actual.

INTRODUCTION: Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. PATIENTS AND METHOD: Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. RESULTS: Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. CONCLUSIONS: Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma.

Sarcomas retroperitoneales. Aportación de cinco nuevos casos y revisión de la situación actual / Retroperitoneal sarcomas. Report of five new cases and review of the current situation

Introducción. Los sarcomas constituyen un grupo muy heterogéneo de tumores infrecuentes que se originan a partir de las células mesenquimales localizadas en el tejido conectivo. De éstos, el 15% es de localización retroperitoneal. Son tumores localmente agresivos cuyo único tratamiento curativo es la resección quirúrgica en bloque con márgenes libres. La principal causa de muerte es la recidiva locorregional. La supervivencia a los 5 años es de un 3-58%, y la evolución varía según el subtipo histológico y el grado de diferenciación del sarcoma. Pacientes y método. Desde 2001 hasta 2006, hemos operado 5 sarcomas retroperitoneales. La media de edad fue de 59 (46-76) años, con una proporción varones:mujeres de 3:2. El dolor y la masa abdominal fueron los signos iniciales más frecuentes. En 2 casos el diagnóstico se realizó incidentalmente en el acto quirúrgico. Resultados. Los 5 casos fueron resecados, si bien fue incompleta en 2. Resecamos 2 liposarcomas, 1 leiomiosarcoma, 1 condrosarcoma y 1 sarcoma fusocelular de origen renal; 4 pacientes refirieron recidiva local y precisaron entre 1 y 2 nuevas resecciones con intención curativa (en esa ocasión realizamos un abordaje retroperitoneal en 2 casos). Registramos una muerte. Conclusiones. Los sarcomas retroperitoneales constituyen un grupo muy heterogéneo de tumores que tienen como único dato común la localización. Creemos que deberían llevarse a cabo estudios prospectivos aleatorizados y multicéntricos para aplicar criterios terapéuticos distintos según el subtipo de sarcoma retroperitoneal (AU)

Introduction: Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. Patients and method. Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. Results. Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. Conclusions. Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma (AU)

Differences in polypropylene shrinkage depending on mesh position in an experimental study.

BACKGROUND: Polypropylene (PP) mesh is one of the most frequent materials used in hernia repair. We have experimentally evaluated the shrinkage of PP mesh depending on the place of implantation. METHODS: In 15 New Zealand rabbits a muscular defect measuring 3 x 3 cm was created in both pararectal sides of the abdominal wall. The defect was repaired using a PP mesh measuring 5 x 3.5 cm that was placed in the right side in the sublay location and in the left side in the onlay location. Five animals were killed on the 30th, 60th, and 90th postoperative days. Macroscopic measurement and microscopic study of the prosthesis-host tissue interfaces were performed. RESULTS: One rabbit was killed because of severe infection in the onlay mesh. Another 2 infections were tolerated in the onlay mesh side. All the prostheses were integrated in the host tissue at death. In the macroscopic evaluation the mesh areas were reduced by 25.92% on the 30th day, by 28.67% on the 60th day, and by 29.02% on the 90th day. The mesh shrinkage was greater in the onlay group than in the sublay group at the 3 time intervals. More inflammatory leukocyte and mononuclear responses also were seen in the onlay group. CONCLUSIONS: These observations support the theory of PP mesh shrinkage as a consequence of the incorporation of the biomaterial to the scarring tissue. This shrinkage is significantly more intense if the meshes are placed in the onlay position.

Seguimiento de la contracción de las mallas de polipropileno empleadas en la reparación de eventraciones / Surveillance of shrinkage of polypropylene mesh used in the repair of ventral hernias

Introducción. El polipropileno (PP) es uno de los biomateriales más empleados en la reparación quirúrgica de las eventraciones. Aunque se conoce bien su capacidad de integración tisular en el huésped, se discute si las mallas sufren un proceso de contracción que reduce su tamaño durante el mecanismo de incorporación al proceso de cicatrización del huésped. Objetivo. Cuantificar el proceso de contracción de las mallas de polipropileno. Pacientes y método. Se ha diseñado un estudio de seguimiento radiológico en 23 pacientes consecutivos operados de eventraciones de la línea media con un diámetro mínimo de 5 cm. Las mallas de polipropileno fueron marcadas con clips de titanio en sus ejes mayores transversal y longitudinal. Se realizaron radiografías seriadas el primer día del postoperatorio, al mes, y a los 3, 6 y 12 meses. Se midieron las distancias entre los clips y se calculó el área de la malla. Resultados. Se operó a 17 mujeres y 6 varones. En 9 pacientes la malla se colocó en el espacio supraponeurótico y en 14 en el espacio subaponeurótico. Se produjeron 4 seromas en los pacientes tratados con malla en situación supraponeurótica. La reducción del área calculada ha sido del 12% al mes, 24% a los 3 meses, 29% a los 6 meses y 34% a los 12 meses. Conclusiones. Las mallas de PP han ofrecido excelentes resultados clínicos. En el seguimiento radiológico se ha comprobado una contracción considerable de la malla, fundamentalmente, durante los primeros 3 meses tras el implante (AU)

Introduction. Polypropylene (PP) mesh is one of the most frequently used materials in the surgical repair of ventral hernias. Despite the widely recognized ability of PP to integrate into the host tissue, these meshes may shrink during the healing process in the patient. Objective. To quantify polypropylene mesh shrinkage. Patients and method. A radiological follow-up study was performed in 23 consecutive patients who underwent surgery for midline ventral hernias with diameters of at least 5 cm. PP meshes were marked with titanium clips at the ends of their longest transverse and longitudinal axes. X-rays were performed on the first postoperative day and at 1, 3, 6 and 12 months. The distances between clips were measured and the area of the mesh was calculated. Results. Seventeen women and six men underwent surgery. In nine patients the mesh was placed on the prefascial space (onlay) and in 14 in the subfascial space (sublay). There were four seromas in patients with mesh placed with the onlay technique. The reduction in the calculated area was 12% at 1 month, 24% at 3 months, 29% at 6 months and 34% at 12 months. Conclusions. PP mesh provided excellent clinical results. Radiological surveillance revealed substantial shrinkage, mainly in the first 3 months after implantation (AU)