Recidiva e incidencia de fístula tras el drenaje urgente de un absceso anal. Resultados a largo plazo / Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results

Introducción: El absceso anal es el problema proctológico urgente más frecuente. La tasa de recidiva y la incidencia de fístula publicada tras el drenaje y desbridamiento de un absceso anal es ampliamente variable. El presente estudio tiene como objetivo analizar la tasa de recurrencia y la incidencia de fístula a largo plazo tras el drenaje y desbridamiento urgente de un absceso anal. Métodos: Estudio observacional retrospectivo de una cohorte prospectiva con absceso anal de origen criptoglandular. Todos los pacientes (n = 303) fueron evaluados a los dos meses y al año de la intervención. Al quinto año se revisaron todas las historias clínicas y se llamó telefónicamente o se citó en consulta para valoración. Se registraron los antecedentes específicos de patología anal, características del absceso, momento y tipo de la recidiva, presencia de sintomatología en la primera revisión y presencia de fístula clínica y/o ecográfica. Resultados: Seguimiento medio de 119,7 meses. Tasa de recidiva 48,2% (82,2% en 1er año). Doscientas veintidós ecografías realizadas. Incidencia de fístula ecográfica: 70% sintomáticos vs. 2,4% asintomáticos (p < 0,001). Incidencia global de fístula 40,3%. Los antecedentes de patología anal y la presencia de clínica en la revisión postoperatoria aumentan significativamente la posibilidad de recidiva (p < 0,001). La fístula es estadísticamente más frecuente si el absceso presenta recurrencia (p < 0,001). Conclusiones: Tras el drenaje y desbridamiento de un absceso anal la mitad de los pacientes recidivan y un 40% desarrollan fístula. Seguimientos mayores de un año no son necesarios. La ecografía endoanal para la evaluación de la presencia de fístula es muy cuestionable en ausencia de signos o síntomas(AU)

Introduction: Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. Methods: Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. Results: Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001). Conclusion: After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms(AU)

Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results.

INTRODUCTION: Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. METHODS: Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. RESULTS: Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001). CONCLUSION: After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.

Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results. / Recidiva e incidencia de fístula tras el drenaje urgente de un absceso anal. Resultados a largo plazo.

INTRODUCTION: Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. METHODS: Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. RESULTS: Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001) CONCLUSION: After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.

Linfoma de tejido linfoide asociado a mucosas primario de mama con infiltración de la piel / Primary mucosa-associated lymphoid tissue lymphoma of the breast with cutaneous involvement

El linfoma de células B extranodal de la zona marginal del tejido asociado a mucosas es de bajo grado de malignidad y representa el 0,04-0,53% de todos los tumores malignos de la mama y el 2,2% de los linfomas malignos extranodales. Se asocia a enfermedades autoinmunes. En la mama se presenta habitualmente como un tumor único, indoloro y de rápido crecimiento. En algunos casos existe compromiso de la piel y adenopatías axilares. Presentamos el caso de una mujer de 39 años con artritis reumatoide de 20 años de evolución, que presenta desde hace 5 meses una tumoración palpable en la mama izquierda de 4 cm y lesiones eritematosas cambiantes en la piel de ambas mamas. Los hallazgos radiológicos fueron similares a los del resto de las tumoraciones malignas, por lo que para su diagnóstico fue necesario un estudio anatomopatológico, inmunohistoquímico y molecular (AU)

Mucosa-associated lymphoid tissue lymphoma is a low-grade malignant tumor representing 0.04 to 0.53% of all malignant breast tumors and 2.2% of extranodal malignant lymphomas. This entity is associated with autoimmune diseases. In the breast, mucosa-associated lymphoid tissue lymphomas usually appear as a single, painless, and fast growing tumor. Some patients also have cutaneous involvement and axillary lymphadenopathy. We present a case of a 39-year-old woman with a 20-year history of rheumatoid arthritis and a 5-month history of a palpable 4 cm lump in the left breast and erythematous skin lesions on both breasts. Radiological findings were similar to those of other malignant tumors. Consequently, histopathological, immunohistochemical and molecular studies were required for diagnosis (AU)

[Training periods with experts improve results in colorectal laparoscopic surgery]. / Las estancias de formación con expertos mejoran los resultados en cirugía laparoscópica colorrectal.

OBJECTIVE: To analyse the effects of training in elective colorectal laparoscopic surgery with a minimum 6 months follow up to assess early and delayed complications, and comparing the first 40 cases in the 1st Period (P-1: 1996-2002) with the 100 cases in the 2nd Period (P-2: 2003-2008). One of the surgeons had two training courses between P-1 and P-2. MATERIAL AND METHODS: A total of 66 colorectal resections due to cancer were performed and 74 operations for benign disease. The cases of malignant diseases increased between P-1 and P-2 (P<0.001). (Odds-Ratio=0.16). RESULTS: There number of complex cases increased between P-1 and P-2 (Anterior resection-amputation, left hemicolectomy, total colectomy, rectopexy) vs. Others (Sigmoidectomy, right resections) (P<0.05), but the mean duration of the operations was reduced by 29 minutes P<0.01). There were 24% conversions, with no change in P-2 (P=0.85). Surgical mortality at 3 months (1.4%) showed no differences (P=0.49). The total complications rate (31%) was significantly lower in P-2 (P=0.001), because medical complications (P=0.05), the more serious surgical complications (with reintervention) (P=0.05) and wound infections (P=0.0001) were lower. There was no change in the other surgical complications (P=0.61). The overall mean stay was 7.8 days (3-36) (median=6 days), with no differences between P-1 and P-2 (P=0.165). Conversion significantly lengthened the mean hospital stay (P=0.015) (from 7.2+/-5 days to 10.1+/-7 days), but there was no increase in complications (P=0.31). CONCLUSION: Training in colorectal laparoscopy and training periods with experts improve results (duration, complications, more complex surgery). Conversions did not decrease with experience and the hospital stays lengthened, but they were not associated with more complications.