Sleep deprivation among surgical residents: Does it affect performance while practising a laparoscopic intestinal anastomosis?

INTRODUCTION: To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS: A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the FATIGUE group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the REST group(R), being those who slept at home for more than 7 h. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS: 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33.5% anastomoses, as opposed to 19.4% in the rest group (P < .01). El rest group performed the anastomosis in 56.75 min and the fatigue group in 61,49 min (P = .006). There were no significant differences in the others parameters. CONCLUSIONS: Fatigue increases the risk of leakage and the time to do the exercise.

Fatiga por deprivación de sueño en residentes de cirugía: ¿Afecta a los resultados al realizar una anastomosis laparoscópica intestinal? / Sleep deprivation among surgical residents: does it affect performance while practising a laparoscopic intestinal anastomosis?

IntroducciónEvaluar el impacto de la fatiga por incorrecto descanso nocturno en la realización de una anastomosis manual laparoscópica.MétodosSe lleva a cabo un estudio prospectivo observacional evaluando la realización de una anastomosis manual enteroenteral en endotrainer por residentes. Se dividen en dos grupos; el grupo descanso incluye a residentes que han dormido en casa siete o más horas vs. al grupo fatiga formado por residentes de guardia o que han dormido menos de siete horas. Se evalúa el tiempo empleado, la longitud de la anastomosis, la correcta tensión de la línea de sutura, la correcta aposición de los bordes, la distancia entre puntos y la fuga de aire, en prueba neumática de estanqueidad.ResultadosSe evalúan 402 anastomosis, siendo 211 pertenecientes al grupo descanso y 191 al grupo fatiga. Se detecta fuga en el 33,5% de las anastomosis del grupo fatiga frente al 19,4% en el grupo descanso (p < 0,01). El tiempo empleado en el grupo descanso es de 56,75 vs. 61,49 min en el grupo fatiga (p = 0,006). No hay diferencias en el resto de los parámetros.DiscusiónLa fatiga aumenta el riesgo de fuga y el tiempo que se tarda en completar el ejercicio (AU)

IntroductionTo assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis.MethodsA prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the fatigue group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the rest group (R), being those who slept at home for more than 7 hours. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches.Results402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33,5% anastomoses, as opposed to 19,4% in the rest group (p < 0.01). El rest group performed the anastomosis in 56,75 min and the fatigue group in 61,49 min (p = 0.006). There were no significant differences in the others parameters (AU)

Sleep deprivation among surgical residents: does it affect performance while practising a laparoscopic intestinal anastomosis? / Fatiga por deprivación de sueño en residentes de cirugía: ¿Afecta a los resultados al realizar una anastomosis laparoscópica intestinal?

INTRODUCTION: To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS: A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the fatigue group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the rest group (R), being those who slept at home for more than 7 hours. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS: 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33,5% anastomoses, as opposed to 19,4% in the rest group (p < 0.01). El rest group performed the anastomosis in 56,75 min and the fatigue group in 61,49 min (p = 0.006). There were no significant differences in the others parameters. CONCLUSIONS: Fatigue increases the risk of leakage and the time to do the exercise.

Predicting factors for the diagnosis of gangrene acute cholecystitis.

Background: Gangrenous cholecystitis (GC) must be promptly treated for its high morbimortality. The object of our study is to identify clinical, laboratory or ultrasound factors that might us diagnose GC. Method: A Retrospective cohort study is devised including all patients admitted to Hospital de Laredo (Cantabria, Spain) between 2015 and 2017 with the diagnose of acute cholecystitis and having been operated. Patients were classified in two groups according to pathology: GC and non-GC. We compared their demographics characteristics, comorbidities, laboratory parameters and ultrasound findings. Results: A total of 115 patients were operated, of whom 32 had CG and 83 CNG. Neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) showed significantly increased levels in GC group (p = 0.042) and CRP (p < 0.0001). To CRP showed an area under the ROC curve of 0.872 (95% confidence interval: 0.797-0.946). Acalculous cholecystitis was significantly associated to GC (24.1 vs. 7%; p < 0.005). In the multivariate analysis only the CPR showed as a predictive factor. A cutting point of CRP at 15.25 mg/dl, that had high sensibility (90.6%) and high negative predictive value (95%). Conclusion: CRP helped identify patients with CG to indicate early surgical intervention.

Antecedentes: La colecistitis aguda gangrenosa (CG) debe tratarse precozmente por su alto riesgo de morbimortalidad. Objetivo: Identificar factores clínicos, analíticos o ecográficos que permitan diagnosticar CG preoperatoriamente. Método: Estudio de cohorte retrospectiva en el Hospital de Laredo (Cantabria, España), entre 2015 y 2017, de pacientes con diagnóstico de colecistitis aguda que hayan sido intervenidos. Se clasificó a los pacientes en dos grupos según el diagnóstico anatomopatológico: CG y colecistitis no gangrenosa (CNG). Se compararon las características demográficas, la comorbilidad, los datos analíticos y los datos ecográficos. Resultados: Fueron operados 115 pacientes, de los cuales 32 tenían CG y 83 tenían CNG. Los pacientes con CG muestran unos valores más altos de índice de neutrófilos/linfocitos (p = 0.042) y de proteína C reactiva (PCR) (p < 0.0001). La colecistitis alitiásica se asoció con mas frecuencia a la CG (24.1 vs. 7.0%; p < 0.005). En el estudio multivariable, solo la PCR se muestra significativa. La PCR mostró un área bajo la curva ROC de 0.872, (intervalo de confianza del 95%: 0.797-0.946). Un punto de corte de PCR de 15.25 mg/dl tuvo una alta sensibilidad (90.6%) y un alto valor predictivo negativo (95%). Conclusión: La PCR ayuda a identificar a los pacientes con CG para indicar una intervención quirúrgica precoz.

Masa abdominal de crecimiento rápido; tumor miofibroblástico inflamatorio / Abdominal mass with rapid growth; inflammatory myofibroblastic tumour

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Flexibilización en el control sobre el uso de clozapina: una gran oportunidad / Flexibilization in controlling the use of clozapine: A great opportunity

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Disfunción sexual persistente tras el tratamiento con inhibidores selectivos de la recaptación de serotonina: a propósito de un caso tras la retirada de paroxetina / Post-serotonine selective reuptake inhibitors persistent sexual dysfunction after serotonine selective reuptake inhibitors treatment: a case report after stopping paroxetine

Evidencias recientes sugieren que la disfunción sexual que aparece con frecuencia durante el tratamiento con inhibidores selectivos de la recaptación de serotonina (ISRS) o con los inhibidores selectivos de la recaptación de serotonina y noradrenalina (IRSN) persiste en algunos pacientes tras la discontinuación del tratamiento. Se presenta un caso clínico que sugiere probabilidad elevada para realizar esta atribución causal tras la retirada de paroxetina, según los criterios sugeridos por Ben-Sheetrit et al. en el artículo «Post-SSRI sexual dysfunction»: varón joven sin enfermedad física concurrente, sin tratamientos farmacológicos ni uso de tóxicos (salvo consumo muy moderado y ocasional de alcohol) y libre de síntomas afectivos en el momento actual que pudieran explicar mejor la presencia de disfunción sexual. Doce semanas después de la retirada de paroxetina, persiste disminución de la libido y dificultades moderadas en el mantenimiento de la erección. El creciente interés por la evaluación de la disfunción sexual secundaria a antidepresivos, y el compromiso sobre la esfera sexual de nuestros pacientes, facilita la identificación de casos (AU)

Recent evidence suggests that the sexual dysfunction that often appears during treatment with selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and noradrenaline reuptake inhibitors (SNRIs) persists in some patients after stopping the treatment. A clinical case is presented that suggests a high probability having a causal relationship to the withdrawal of paroxetine according to the criteria suggested by Ben-Sheetrit et al. In the article 'Post-SSRI sexual dysfunction': a young male with no concurrent physical illness, with no drug treatments or use of toxic substances (except for very moderate and occasional consumption of alcohol), and free of affective symptoms at the present moment that could better explain the presence of sexual dysfunction. Twelve weeks after withdrawal of paroxetine, there was a persistent decrease in libido and moderate difficulties in maintaining erection. The increasing interest in the evaluation of sexual dysfunction secondary to antidepressants, and the commitment on the sexual sphere of our patients, facilitates the identification of cases (AU)

Descompresión mediante catéter de un neumoperitoneo a tensión tras la realización de una colonoscopia / Catheter decompression of a tension pneumoperitoneum after colonoscopy

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Embolia aérea cerebral masiva tras colangiopancreatografía retrógrada endoscópica. Presentación de un caso y revisión de la bibliografía / Massive cerebral air embolism following endoscopic retrograde cholangiopancreatography. A case report and review of the literature

Introducción. La embolia aérea cerebral tras procesos endoscópicos es una complicación infrecuente, pero que puede tener consecuencias catastróficas. Caso clínico. Varón de 85 años, diagnosticado de colangiocarcinoma distal con criterios de irresecabilidad, al cual se coloca una prótesis biliar de drenaje. Se realiza una colangiopancreatografía retrógrada endoscópica para el cambio de prótesis. Tras el procedimiento, el paciente sufre un deterioro de las constantes vitales y del nivel de consciencia, y requiere intubación orotraqueal. En la tomografía axial computarizada craneal se evidencia una embolia aérea masiva con focos de isquemia hiperaguda en ambos hemisferios. El paciente fallece posteriormente. Conclusiones. El embolismo aéreo cerebral tras una colangiopancreatografía retrógrada endoscópica es infrecuente, pero potencialmente letal. La manipulación de la pared biliointestinal en las exploraciones endoscópicas podría originar comunicaciones entre la luz y el sistema venoso. Esto, unido a la alta presión de insuflación para la realización de la prueba, condicionaría el paso de aire al sistema venoso portal y, de ahí, al sistema circulatorio. En el sistema nervioso central, las burbujas de aire provocarían una obstrucción vascular, con la consiguiente isquemia y necrosis del tejido. Es fundamental un diagnóstico precoz y una terapia de soporte vital. Su rápido manejo puede contribuir a un mejor pronóstico, que en principio es sombrío (AU)

Introduction. Cerebral air embolism following endoscopic processes is an infrequent complication, but can have catastrophic consequences. Case report. An 85-year-old male diagnosed with distal cholangiocarcinoma with criteria for unresectability who was submitted to placement of a biliary drainage prosthesis. Endoscopic retrograde cholangiopancreatography was performed to change the prosthesis. After the procedure, the patient’s vital signs and level of consciousness underwent a decline, and orotracheal intubation was required. A computerised axial tomography scan of the head showed evidence of a massive air embolism with focal points of hyperacute ischaemia in both hemispheres. The patient later died. Conclusions. Cerebral air embolism following endoscopic retrograde cholangiopancreatography is infrequent, but potentially lethal. Manipulation of the bilio-intestinal wall in endoscopic examinations could give rise to communications between the lumen and the venous system. This, together with the high insufflation pressure used to conduct this test, would condition the passage of air to the portal venous system, and from there to the circulatory system. In the central nervous system, air bubbles would lead to a vascular obstruction, with the subsequent ischaemia and necrosis of tissues. An early diagnosis and life support therapy are essential. Its timely management can contribute to a better prognosis which, at least initially, is gloomy (AU)