Medial incisional ventral hernia repair with Adhesix® autoadhesive mesh: descriptive study.

Nowadays, the gold standard for the surgical treatment of abdominal wall defects is the use of a mesh. There is an extensive variety of meshes, self-adhesive ones being among the most novel technologies. The literature on the self-adhesive mesh Adhesix® (Cousin Biotech Laboratory, 59117 Wervicq South, France) in medial incisional ventral hernia is scarce. We performed a retrospective descriptive study with prospective data collection from 125 patients who underwent prosthetic repair of medial incisional ventral hernia-M1-M5 classification according to European Hernia Society (EHS)-with self-adhesive mesh Adhesix® between 2013 and 2021. Follow-up was performed 1 month and yearly after the surgery. Postoperative complications and hernia recurrences were recorded. Epidemiological results were average BMI 30.5 kg/m2 (SD 5), highlighting that overweight (41.6%) and obesity type 1 (25.6%) were the most represented groups. 34 patients (27.2%) had already undergone a previous abdominal wall surgery. The epigastric-umbilical (M2-M3 EHS classification, 22.4%) and umbilical (M3 EHS classification, 20%) hernias were the predominant groups. The elective surgery technique was Rives or Rives-Stoppa with an associated supraaponeurotic mesh if the closure of the anterior aponeurosis of the rectus sheath was not surgically closed (13 patients). The most frequent postoperative complication was seroma (26.4%). The recurrence rate was 7.2%. The average follow-up length was 2.6 years (SD 1.6 years). According to the results of this study and the literature available, we consider that the self-adhesive mesh Adhesix® is an appropriate alternative mesh option for the repair of medial incisional ventral hernias.

Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery.

Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.

RELAY, ramucirumab plus erlotinib versus placebo plus erlotinib in patients with untreated, EGFR-mutated, metastatic non-small cell lung cancer: Europe/United States subset analysis.

BACKGROUND: In EGFR mutation-positive NSCLC, dual EGFR/VEGFR inhibition compared to EGFR alone increases anti-tumor efficacy. The Phase III RELAY trial demonstrated superior PFS for ramucirumab plus erlotinib (RAM + ERL) over placebo plus erlotinib (PBO + ERL) (HR 0.591 [95% CI 0.461-0.760], p<0.0001). EGFR mutated NSCLC is less prevalent in Western versus Asian patients. This prespecified analysis evaluates efficacy and safety of RAM + ERL in EU and US patients enrolled in RELAY. PATIENTS AND METHODS: Patients were randomized 1:1 to ERL + RAM (10 mg/kg IV) or PBO Q2W. Treatment continued until unacceptable toxicity or progressive disease. Patients were stratified by geographic region (East Asia vs "other" [EU/US and Canada (EU/US)]). Objectives included PFS, ORR, DoR, OS, PFS2, safety and biomarker analysis. RESULTS: EU/US subset included 113/449 (25.9%) patients (58 RAM + ERL, 55 PBO + ERL). RAM + ERL improved PFS (20.6 vs 10.9 months, HR 0.605 [95% CI: 0.362-1.010]). ORR and DCR were similar, but median DoR was longer with RAM + ERL (18.0 vs 10.1 months, HR 0.527 [95% CI: 0.296-0.939]). OS and PFS2 were immature at data cut-off (censoring rates 81.0-81.8% and 67.3-79.3%, respectively). Most commonly reported Grade ≥3 TEAE for RAM + ERL was hypertension (17 [29.8%]) and for PBO + ERL, dermatitis acneiform (5 [9.1%]). CONCLUSION: EU/US subset analysis showed improved efficacy outcomes for RAM + ERL and a safety profile consistent with the overall population. Ramucirumab is a safe and effective addition to standard-of-care EGFR-TKI for EGFR mutation-positive metastatic NSCLC.

[Presurgical preparation and surgical site infection in neck surgery. The effect of the protocol adequacy in the improvement of the health care quality]. / Impacto de la adecuación del protocolo de preparación prequirúrgica en la incidencia de infección de localización quirúrgica en cirugía cervical.

BACKGROUND: Surgical wound infection is one of the leading causes of healthcare-associated infections. One of the most common measures for its reduction is the pre-surgical preparation. The aim of this study was to evaluate the adequacy to the pre-surgical protocol in patients undergoing neck surgery and the relationship with the incidence of surgical wound infection. MATERIAL AND METHODS: Observational cohort study, conducted from January 2011 to December 2017. Variables related to patient, pre-surgical preparation and infection were collected. Infection rate was calculated after a maximum period of 30days after surgery. The effect of the pre-surgical preparation's adequacy and infection was evaluated. RESULTS: The study included 131 patients. The global adequacy of the pre-surgical protocol was 84.7%, being the main cause of inadequacy the application of the mouthwash (7.6% of the interventions). The overall incidence of surgical wound infection during the follow-up period was 4.6% (95%CI: 1.0%-8.2%). No relationship between the adequacy to the protocol and the presence of infection was found (P=.59). CONCLUSIONS: Adequacy of the pre-surgical preparation in our hospital was high and the incidence of surgical wound infection was low, and no relationship was found between the two. The results show a high safety culture in this surgery. However, there is still room for improvement in the quality of care of our patients.

Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study. / Incidencia de infección de herida quirúrgica en cirugía renal. Efecto de la adecuación de la profilaxis antibiótica. Estudio de cohortes prospectivo.

OBJECTIVE: To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. MATERIAL AND METHODS: We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. RESULTS: The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR=0.26; 95%CI: 0.1-1.2; P>.05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR=0.10; 95%CI: 0.01-0.79). CONCLUSIONS: The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery.

Incidencia de infección de herida quirúrgica en cirugía renal. Efecto de la adecuación de la profilaxis antibiótica. Estudio de cohortes prospectivo / Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study

Objetivo: Evaluar la adecuación a protocolo de la profilaxis antibiótica en pacientes intervenidos de cirugía renal y su efecto en la incidencia de infección de localización quirúrgica. Material y métodos: Se realizó un estudio prospectivo de cohortes. Se evaluó la adecuación global y de cada apartado de la profilaxis antibiótica (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Las variables cualitativas se han comparado con la prueba Chi2 y las cuantitativas con la prueba t-Student. Se ha estudiado el efecto de la adecuación de la profilaxis antibiótica, en la incidencia de infección de localización quirúrgica en la cirugía renal, con el riesgo relativo. Resultados: Se incluyeron 266 pacientes en el estudio. La adecuación global fue del 90,6%. La mayor causa de inadecuación fue el inicio de la profilaxis, con un 3,8%. La incidencia de infección de localización quirúrgica fue del 3,4%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de localización quirúrgica (RR = 0,26; IC 95%: 0,1-1,2; p > 0,05). La cirugía laparoscópica tuvo menor incidencia de infección de localización quirúrgica que la cirugía abierta (RR = 0,10; IC 95%: 0,01-0,79). Conclusiones: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de localización quirúrgica fue baja y no hubo relación entre la incidencia de infección de localización quirúrgica y la adecuación a la profilaxis antibiótica. La incidencia de infección fue menor en la cirugía laparoscópica

Objective: To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. Material and methods: We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. Results: The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR = 0.26; 95% CI: 0.1-1.2; P > .05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR = 0.10; 95% CI: 0.01-0.79). Conclusions: The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery

Incidencia de infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio de cohortes prospectivo / Incidence of surgical site infection in colon surgery and antibiotic prophylaxis adequacy: prospective cohort study

Fundamento: La infección de localización quirúrgica (ILQ) tiene un considerable impacto clínico y económico a nivel hospitalario, por lo que se consideran prioritarios su prevención y seguimiento. El objetivo de este estudio fue la evaluación del cumplimiento del protocolo de profilaxis antibiótica en la cirugía de colon y el efecto de su inadecuación en la incidencia de ILQ. Material y métodos: Se realizó un estudio de cohortes prospectivo desde julio de 2008 a julio de 2016. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y las causas de incumplimiento en cirugía de colon: duración e inicio, elección, vía de administración y dosis de antibiótico. Se estudió la incidencia de ILQ después de un período máximo de incubación de 30 días. Para evaluar el efecto del incumplimiento de la profilaxis en la ILQ se usó el riesgo relativo (RR). Resultados: El estudio incluyó 771 pacientes. La incidencia acumulada de ILQ fue del 5,8%, la mayoría (67%) infecciones incisionales superficiales. La etiología más frecuente de ILQ fue Escherichia coli (28%). La profilaxis antibiótica se administró en el 97,8% de los pacientes, con un cumplimiento global del protocolo del 91,9%. La causa principal de incumplimiento fue la elección del antibiótico (58,2%). No se encontró relación entre inadecuación de la profilaxis e incidencia de infección de localización quirúrgica (RR=0,5; IC95% 0,1-1,8). Conclusiones: La tasa global de adecuación al protocolo de profilaxis antibiótica fue alta. No se encontró asociación significativa entre adecuación de la profilaxis e incidencia de ILQ en cirugía de colo (AU)

Background: Surgical site infection (SSI) has a considerable clinical and economic impact at the hospital level, so prevention and monitoring are considered a high priority. The objective of this study was to assess compliance with the protocol of antibiotic prophylaxis in colon surgery and the effect of its inadequacy for the incidence of SSI. Methods: Prospective cohort study from July 2008 to July 2016. Compliance with antibiotic prophylaxis protocol and the causes of non-compliance were evaluated in colon surgery: duration and starting, choice, route of administration and dose of the antibiotic. The incidence of SSI was studied after a maximum incubation period of 30 days. Relative risk (RR) was used to evaluate the non-compliance causes of prophylaxis. Results: The study included 771 patients. The cumulative incidence of SSI was 5.8% (n=45), of which 2/3 were superficial incisional infections. The most common cause of SSI was Escherichia coli (28%). Antibiotic prophylaxis was administered in 97.8% of patients, with an overall protocol compliance of 91.9%. The principle cause of non-compliance was the choice of antibiotic (58.2%). No relationship between the inadequacy of prophylaxis and incidence of surgical site infection was found (RR=0.5; CI95% 0.1-1.8). Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol was high. No significant association between the adequacy of prophylaxis and incidence of surgical site infection in colon surgery was foun (AU)

[Incidence of surgical site infection in colon surgery and antibiotic prophylaxis adequacy: prospective cohort study]. / Incidencia de infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio de cohortes prospectivo.

BACKGROUND: Surgical site infection (SSI) has a considerable clinical and economic impact at the hospital level, so prevention and monitoring are considered a high priority. The objective of this study was to assess compliance with the protocol of antibiotic prophylaxis in colon surgery and the effect of its inadequacy for the incidence of SSI. METHODS: Prospective cohort study from July 2008 to July 2016. Compliance with antibiotic prophylaxis protocol and the causes of non-compliance were evaluated in colon surgery: duration and starting, choice, route of administration and dose of the antibiotic. The incidence of SSI was studied after a maximum incubation period of 30 days. Relative risk (RR) was used to evaluate the non-compliance causes of prophylaxis. RESULTS: The study included 771 patients. The cumulative incidence of SSI was 5.8% (n=45), of which 2/3 were superficial incisional infections. The most common cause of SSI was Escherichia coli (28%). Antibiotic prophylaxis was administered in 97.8% of patients, with an overall protocol compliance of 91.9%. The principle cause of non-compliance was the choice of antibiotic (58.2%). No relationship between the inadequacy of prophylaxis and incidence of surgical site infection was found (RR=0.5; CI95% 0.1-1.8). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol was high. No significant association between the adequacy of prophylaxis and incidence of surgical site infection in colon surgery was found.

Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer.

Streptococcus bovis group and Enterococcus spp. share phenotypic characteristics and intestinal habitat. Both have been associated with endocarditis and colorectal neoplasm (CRN). We studied all cases of endocarditis diagnosed between 1988 and 2014 in our centre and caused by S. bovis (109, 48.8 % of the bacteremia) and by Enterococcus spp. (36, 3.4 % of the bacteremia). Patients were seen until death or during a long-term follow-up, in order to rule out a concomitant CRN. The 109 cases of S. bovis endocarditis (SbIE) compared with the 36 caused by enterococci showed: a higher proportion of males (91 % vs. 72 %, p=0.005), more multivalvular involvement (28 % vs. 6 %, p=0.004), embolic complications (44 vs. 22 %, p=0.02) and colorectal neoplasm (64 % vs. 25 %, p=0.001). SbIE showed fewer co-morbidities (32 vs. 58 %, p=0.005), and less frequently urinary infection source (0 vs. 25 %, p=0.001) and healthcare-related infection (2 vs. 44 %, p=0.001). A total of 123 patients were followed up for an extended period (mean: 65.9 ± 57.5 months). During the follow-up, 6 of 28 (21 %) cases with enterococcal endocarditis and 43 of 95 (45.2 %, p=0.01) cases with SbIE developed a new CRN. These neoplasiae appeared a mean of 60.4 months later (range 12-181 months). Among the 43 cases with SbIE and CRN, 12 had had a previously normal colonoscopy and 31 had had a previous CRN and developed a second neoplasm. Cases of SbIE present important differences with those caused by Enterococcus spp. Colonoscopy must be mandatory both in the initial evaluation of SbIE, as during the follow-up period.

Ovarian hydatid disease.

Hydatid disease, also known as Echinococcosis is a zoonosis caused by the larval stage of Echinococcus. The human cystic variant primarily affects liver and lungs. The pelvic location of the disease is a rare finding usually secondary to a ruptured liver cyst, although it may also appear as a primary lesion affecting the genital organs. Despite its rarity, in endemic areas, pelvic hydatid disease should be considered in the differential diagnosis of complex adnexal cystic mass, to make an appropriate treatment strategy. The suspected diagnosis is based on imaging studies and serodiagnostic techniques, in which a new field of research attempts to find a standardized test with sufficient sensitivity and specificity. We report a case of primary pelvic hydatid disease in postmenopausal women operated for suspected ovarian cancer.

[Longitudinal study of the growth of preterm newborn infants]. / Estudio longitudinal de crecimiento de recién nacidos pretérmino.

BACKGROUND: The growth and nutrition of premature infants should be accurately assessed. To do this, reference values of normality, obtained from population to be studied, are required. OBJECTIVES: To study the postnatal growth of premature infants in our environment and to compare their growth with intrauterine growth (Lubchenco et al). PATIENTS: A total of 103 premature infants born at 28-36 weeks of gestation in the Virgen de la Arrixaca University Children's Hospital in Murcia (Spain) from April 1994 to June 1995 were studied. Children who received medical care during the first 24 hours of life and who had no prenatal condition that could affect their growth were selected. Those who suffered from serious disease were excluded. The study was carried out from birth to a postconceptional age of 48-52 weeks. The 2-step regression model was used to calculate the percentile graphs. RESULTS: Percentile growth graphs were drawn up for the following variables: weight, length, arm circumference, head circumference, subscapular fold, and tricipital fold. In premature infants, postnatal growth in weight and length was uniform, progressive, and practically linear and did not show the flattening that is characteristic of intrauterine growth. Other corporal segments such as the head and arm circumference showed a certain slowing down at a postconceptional age of 42 or 43 weeks, and the folds showed a moderate dispersion of values as the study progressed. CONCLUSIONS: Intrauterine growth charts do not accurately assess postnatal growth in premature infants.

Estudio longitudinal de crecimiento de recién nacidos pretérmino / Longitudinal study of the growth of preterm newborn infants

Antecedentes. Es importante la valoración adecuada del crecimiento y nutrición de los recién nacidos pretérmino. Es preciso para ello disponer de valores de referencia de normalidad, obtenidos de la población que se va a estudiar. Objetivos. Estudiar el crecimiento posnatal de nuestros recién nacidos pretérmino, y comparar este crecimiento con el crecimiento intrauterino. Pacientes. Se incluyen 103 recién nacidos pretérmino de 28 a 36 semanas de gestación, ingresados en el Hospital Universitario Infantil Virgen de la Arrixaca de Murcia en el período comprendido entre abril de 1994 y junio de 1995. Se seleccionaron niños captados en las primeras 24 h de vida, sin condiciones prenatales que afectaran al crecimiento. Se excluyeron aquellos que sufrían enfermedad grave. Se realizó el estudio desde el nacimiento hasta las semanas 48 a 52 de edad posconcepcional. Se utilizó el modelo de regresión en dos etapas como método estadístico para el cálculo de las gráficas de percentiles. Resultados. Se construyeron gráficas de crecimiento de percentiles para los siguientes parámetros: peso, longitud, perímetro de brazo, perímetro cefálico, pliegue subescapular y pliegue tricipital. El crecimiento posnatal de los recién nacidos pretérmino en peso y longitud es uniforme, progresivo, prácticamente lineal, y no muestra el aplanamiento característico del crecimiento intrauterino. Otros segmentos corporales como perímetro cefálico, perímetro de brazo, experimentan una cierta disminución de la velocidad de crecimiento a las 42 o 43 semanas de edad posconcepcional, los pliegues muestran moderada dispersión de valores al avanzar el período de estudio. Conclusiones. Las gráficas de crecimiento intrauterino no son adecuadas para valorar el crecimiento posnatal del recién nacido pretérmino (AU)

Morbimortalidad atribuible a la fístula esofagoyeyunal tras gastrectomía total por cáncer gástrico / Morbidity and mortality due to esophagojejunal anastomotic fistula after total gastrectomy for gastric cancer

Objetivo. Determinar la morbilidad y la mortalidad postoperatoria atribuible a la fístula anastomótica esofagoyeyunal tras la gastrectomía total por cáncer gástrico. Diseño. Estudio retrospectivo de cohortes. Pacientes y métodos. Desde 1991 hasta noviembre de 2000, se realizaron 135 gastrectomías totales consecutivas. La fístula esofagoyeyunal se estableció cuando existía fuga de contraste. La cohorte de estudio está formada por 13 pacientes con fístula. Entre los 122 pacientes restantes sin fístula se seleccionó una cohorte control de 17 casos mediante una técnica de muestreo sistemático emparejando los procedimientos por la experiencia del cirujano y por la extensión de la cirugía. Se analizó la mortalidad, la infección intraabdominal, la infección pulmonar, el absceso de pared, la infección por catéter, el índice de reintervenciones y la estancia media postoperatoria. Resultados. La fístula esofagoyeyunal incrementó significativamente la incidencia de absceso intraabdominal (61,5 por ciento frente a 11,9 por ciento; p = 0,008; RR = 5,1) y la mortalidad postoperatoria (38,4 por ciento frente a 5,8 por ciento; p = 0,05; RR = 6,6). La infección pulmonar y el absceso de pared fueron más frecuentes en el grupo de pacientes con fístula pero no alcanzaron significación estadística. La estancia hospitalaria postoperatoria fue, como promedio, 12 días más larga en los pacientes con fístula (p = 0,03).Conclusiones. La fístula esofagoyeyunal es una complicación muy grave que multiplica la tasa de mortalidad postoperatoria y que depende directamente de la experiencia del cirujano. Hay que organizar equipos especializados que realicen periódicamente estos procedimientos complejos y que protocolicen el tratamiento de estos pacientes (AU)

Estenosis pilórica péptica tratada con endoprótesis / Peptic pyloric stenosis treated by an endoprothesis

No disponible

Enfoque epidemiológico del programa de diagnóstico precoz del cáncer cérvico uterino

Se realiza un análisis de los principales resultados del programa de detención precoz del cáncer cérvico uterino en la provincia de Cienfuegos, precisándose algunos elementos que inciden negativamente en el programa como son:El porcentaje de menores de 30 años, la limitada incorporación de mujeres con el primer examen y la existencia de recursos;se establecen relaciones entre aspectos y se reflexiona sobre la impoprtancia de incrementar la cobertura en los grupos de mayor riesgo,así como de aumentar, acorde a los recursos existentes, el riesgo entre el primer exameny los siguientes