Synchronous colorectal cancer and abdominal aortic aneurysm treated simultaneously. Is a one-stage surgery a feasible treatment?

The finding of synchronous abdominal aortic aneurysm and colorectal cancer is rare. There is no consensus on which is the best surgical approach, so its management remains uncertain. A 64-year-old man was diagnosed with synchronous abdominal aortic aneurysm and rectal cancer. One-stage treatment was performed: He underwent endovascular aortic repair followed by simultaneous laparoscopic tumor resection. In our experience, one-stage minimally invasive surgery could be a safe and feasible treatment for concomitant abdominal aortic aneurysm and colorectal cancer.

Early and late results of open surgical and endovascular treatment of infrarenal abdominal aortic aneurysms, selected according to surgical risk.

BACKGROUND: Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) surgery are alternative treatments for infrarenal abdominal aortic aneurysm (IRAAA). OBJECTIVES: To compare OSR and EVAR for the treatment of IRAAA. METHODS: 119 patients with IRAAA were electively operated by the same surgeon between January 1, 2006 and December 31, 2015, following selection for OSR or EVAR according to surgical risk. Complications, reinterventions, failures, and early and late mortality were analyzed. RESULTS: 63 OSR and 56 EVAR patients were analyzed. They were similar in terms of age (70 years), gender (92% men), and average diameter of IRAAA (6.5 cm), but with different comorbidities, surgical risk, and anatomy. EVAR was better than OSR regarding time in the operating theatre (177.5 vs. 233.3 minutes), need for transfusion (25 vs. 73%), and length of stay in ICU (1.3 vs. 3.3 days) and hospital (8.1 vs. 11.1 days). OSR allowed more associated procedures to be conducted simultaneously (19.0 vs. 1.8%). There were no significant differences between the groups with respect to complications (25.4 vs. 25.1%), reinterventions (3.2 vs. 5.2%), or early mortality (1.6 vs. 0%). During follow-up, OSR was associated with fewer revisions (3.13 vs. 4.21), angio-CTs (0.22 vs. 3.23), complications (6.4 vs. 37.5%), reinterventions (3.2 vs. 23.2%), and failures (1.6 vs. 10.7%), and had better survival (78.2 vs. 63.2%). CONCLUSIONS: Correct selection of patients achieves excellent results because it avoids OSR in patients at high risk and avoids EVAR in patients with high anatomical complexity, achieving similar results in the perioperative period, but better results for OSR over the course of follow-up.

CONTEXTO: A cirurgia aberta (CA) e o reparo endovascular de aneurisma (REVA) são tratamentos alternativos para o aneurisma da aorta abdominal infrarrenal (AAAIR). OBJETIVOS: Comparar CA e REVA no tratamento do AAAIR. MÉTODOS: Foram incluídos 119 pacientes com AAAIR, operados eletivamente pelo mesmo cirurgião entre 1 de janeiro de 2006 e 31 de dezembro de 2015, após seleção para CA ou REVA de acordo com o risco cirúrgico. Complicações, reintervenções, falhas e mortalidade precoce e tardia foram analisadas. RESULTADOS: Foram analisados 63 pacientes de CA e 56 de REVA, com semelhanças de idade (70 anos), sexo (92% homens) e diâmetro médio do AAAIR (6,5 cm), mas com diferentes comorbidades, riscos cirúrgicos e anatomias. O REVA foi melhor que a CA em relação ao tempo na sala de cirurgia (177,5 vs. 233,3 minutos), necessidade de transfusão (25 vs. 73%) e tempo de permanência na unidade de terapia intensiva (1,3 vs. 3,3 dias) e no hospital (8,1 vs. 11,1 dias). A CA permitiu que mais procedimentos associados fossem realizados simultaneamente (19,0 vs. 1,8%). Não houve diferenças significativas entre os grupos em relação a complicações (25,4 vs. 25,1%), reintervenções (3,2 vs. 5,2%) e mortalidade precoce (1,6 vs. 0%). Durante o acompanhamento, a CA apresentou menos revisões (3,13 vs. 4,21), angiotomografias (0,22 vs. 3,23), complicações (6,4 vs. 37,5%), reintervenções (3,2 vs. 23,2%) e falhas (1,6 vs. 10,7%), além de ter melhor sobrevida (78,2 vs. 63,2%). CONCLUSÕES: A seleção correta dos pacientes proporciona excelentes resultados porque evita pacientes com alto risco para CA e com complexidade anatômica para REVA. Os resultados são semelhantes no período perioperatório, mas melhores para CA durante o acompanhamento.

Early and late results of open surgical and endovascular treatment of infrarenal abdominal aortic aneurysms, selected according to surgical risk / Resultados precoces e tardios dos tratamentos aberto e endovascular de aneurismas da aorta abdominal infrarrenal, selecionados de acordo com o risco cirúrgico

Abstract Background Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) surgery are alternative treatments for infrarenal abdominal aortic aneurysm (IRAAA). Objectives To compare OSR and EVAR for the treatment of IRAAA. Methods 119 patients with IRAAA were electively operated by the same surgeon between January 1, 2006 and December 31, 2015, following selection for OSR or EVAR according to surgical risk. Complications, reinterventions, failures, and early and late mortality were analyzed. Results 63 OSR and 56 EVAR patients were analyzed. They were similar in terms of age (70 years), gender (92% men), and average diameter of IRAAA (6.5 cm), but with different comorbidities, surgical risk, and anatomy. EVAR was better than OSR regarding time in the operating theatre (177.5 vs. 233.3 minutes), need for transfusion (25 vs. 73%), and length of stay in ICU (1.3 vs. 3.3 days) and hospital (8.1 vs. 11.1 days). OSR allowed more associated procedures to be conducted simultaneously (19.0 vs. 1.8%). There were no significant differences between the groups with respect to complications (25.4 vs. 25.1%), reinterventions (3.2 vs. 5.2%), or early mortality (1.6 vs. 0%). During follow-up, OSR was associated with fewer revisions (3.13 vs. 4.21), angio-CTs (0.22 vs. 3.23), complications (6.4 vs. 37.5%), reinterventions (3.2 vs. 23.2%), and failures (1.6 vs. 10.7%), and had better survival (78.2 vs. 63.2%). Conclusions Correct selection of patients achieves excellent results because it avoids OSR in patients at high risk and avoids EVAR in patients with high anatomical complexity, achieving similar results in the perioperative period, but better results for OSR over the course of follow-up.

Resumo Contexto A cirurgia aberta (CA) e o reparo endovascular de aneurisma (REVA) são tratamentos alternativos para o aneurisma da aorta abdominal infrarrenal (AAAIR). Objetivos Comparar CA e REVA no tratamento do AAAIR. Métodos Foram incluídos 119 pacientes com AAAIR, operados eletivamente pelo mesmo cirurgião entre 1 de janeiro de 2006 e 31 de dezembro de 2015, após seleção para CA ou REVA de acordo com o risco cirúrgico. Complicações, reintervenções, falhas e mortalidade precoce e tardia foram analisadas. Resultados Foram analisados 63 pacientes de CA e 56 de REVA, com semelhanças de idade (70 anos), sexo (92% homens) e diâmetro médio do AAAIR (6,5 cm), mas com diferentes comorbidades, riscos cirúrgicos e anatomias. O REVA foi melhor que a CA em relação ao tempo na sala de cirurgia (177,5 vs. 233,3 minutos), necessidade de transfusão (25 vs. 73%) e tempo de permanência na unidade de terapia intensiva (1,3 vs. 3,3 dias) e no hospital (8,1 vs. 11,1 dias). A CA permitiu que mais procedimentos associados fossem realizados simultaneamente (19,0 vs. 1,8%). Não houve diferenças significativas entre os grupos em relação a complicações (25,4 vs. 25,1%), reintervenções (3,2 vs. 5,2%) e mortalidade precoce (1,6 vs. 0%). Durante o acompanhamento, a CA apresentou menos revisões (3,13 vs. 4,21), angiotomografias (0,22 vs. 3,23), complicações (6,4 vs. 37,5%), reintervenções (3,2 vs. 23,2%) e falhas (1,6 vs. 10,7%), além de ter melhor sobrevida (78,2 vs. 63,2%). Conclusões A seleção correta dos pacientes proporciona excelentes resultados porque evita pacientes com alto risco para CA e com complexidade anatômica para REVA. Os resultados são semelhantes no período perioperatório, mas melhores para CA durante o acompanhamento.

Executive Summary of the Consensus Statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP), on the Management of Cystic Echinococcosis / Resumen ejecutivo de la Declaración de consenso de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI), la Asociación Española de Cirujanos (AEC), la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) y la Sociedad Española de Infectología Pediátrica (SEIP) sobre el tratamiento de la equinococosis quística

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved

La Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI), la Asociación Española de Cirujanos (AEC), la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) y la Sociedad Española de Infectología Pediátrica (SEIP) han considerado pertinente la elaboración de una declaración de consenso sobre el tratamiento de la equinococosis quística (EQ) que sirva de ayuda al personal sanitario en la atención de pacientes con EQ. Varios tipos de profesionales (médicos, cirujanos, radiólogos, microbiólogos y parasitólogos) han seleccionado las preguntas más clínicamente relevantes y han desarrollado esta Declaración de consenso, en la que evalúan los datos basados en la evidencia disponibles para proponer una serie de recomendaciones sobre el tratamiento de esta enfermedad. Esta Declaración de consenso se acompaña de la bibliografía correspondiente que fundamenta estas recomendaciones. Antes de su publicación, el manuscrito estuvo abierto a comentarios y sugerencias de los miembros de la SEIMC y de los comités científicos y juntas directivas de las diferentes sociedades implicadas

Decision-making and therapeutic options in intact splenic artery aneurysms: single-center experience and literature review.

BACKGROUND: Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed. METHODS: We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic. RESULTS: At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past. CONCLUSIONS: The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.

Executive Summary of the Consensus Statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP), on the Management of Cystic Echinococcosis.

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved.

[Segmentary testicular infarction]. / Infarto segmentario de testículo.

OBJECTIVE: A new case of segmental testicular infarction is reported. METHODS: A 52-year-old man presented to the emergency department with severe pain in the left testicle over a few days period. Physical examination revealed a tender induration in the upper pole of the left testicle. Beta-human chorionic gonadotropin and alpha-fetoprotein were normal. Sonography demonstrated a poorly-defined, hypoechoic, 13 mm lesion. On power Doppler sonography, the hypoechoic area appeared completely avascular in contrast to the rest of the testicle. RESULTS: Since testicular tumor was the initial diagnosis, the patient underwent a left radical orchiectomy. Pathological study revealed a focal testicular infarction, without signs of malignancy or vasculitis. CONCLUSIONS: Segmental testicular infarction is usually diagnosed after radical orchiectomy, performed when testicular tumor is suspected. On certain occasions Doppler ultrasound and magnetic resonance imaging findings suggested a segmental testicular infarction. However, if tumor cannot be entirely excluded, exploratory surgery is necessary.

Infarto segmentario de testículo / Segmentary testicular infarction

OBJETIVO: Se presenta un nuevo caso de infarto segmentario de testiculo.METODOS: Paciente de 52 anos que solicito valoracion por dolor en hemiescroto izquierdo de varios dias de evolucion. En la exploracion fisica presentaba una induracion palpable, dolorosa al tacto, en el polo superior del testiculo izquierdo. Los marcadores tumorales (ƒÀ-hCG y ƒ¿-fetoproteina) fueron normales. En el estudio ultrasonografico se aprecio una lesion nodular hipoecogenica intratesticular izquierda de 13 mm de diametro, de bordes ligeramente irregulares, que no mostraba flujo en el analisis con Doppler color.RESULTADO: Con el diagnostico de tumoracion testicular izquierda se realizo orquiectomia por via inguinal. Al corte dicha induracion se correspondia con un nodulo bien delimitado. El estudio histopatologico mostro que la lesion correspondia a un infarto testicular segmentario, sin evidencia de malignidad ni signos de vasculitis.CONCLUSIONES: La forma mas habitual de diagnostico del infarto segmentario de testiculo se produce durante el estudio histopatologico de las piezas de orquiectomia radical realizadas por sospecha de tumor.La ultrasonografia con Doppler y la resonancia magnetica nuclear tienen alta fiabilidad diagnostica, si bien puede resultar dificil descartar categoricamente un tumor de testiculo. En estos casos se puede recurrir a la exploracion con biopsia que confirme la lesion isquemica no tumoral(AU)

OBJECTIVE: A new case of segmental testicu-lar infarction is reported.METHODS: A 52-year-old man presented to the emergency department with severe pain in the left testicle over a few days period. Physical examination revealed a tender indura-tion in the upper pole of the left testicle. ƒÀ-human chorionic gonadotropin and ƒ¿-fetoprotein were normal. Sonography demonstrated a poorly-defined, hypoechoic, 13 mm lesion. On power Doppler sonography, the hypoechoic area appeared completely avascular in contrast to the rest of the testicle.RESULTS: Since testicular tumor was the initial diagnosis, the patient underwent a left radical orchiectomy. Pathological study revealed a focal testicular infarction, without signs of malignancy or vasculitis.CONCLUSIONS: Segmental testicular infarction is usually diagnosed after radical orchiectomy, performed when testi-cular tumor is suspected.On certain occasions Doppler ultrasound and magnetic resonance imaging findings suggested a segmental testicular infarction. However, if tumor cannot be entirely excluded, exploratory surgery is necessary(AU)

[Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology]. / Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Interés de la angiografía y procedimientos neurorradiológicos intervencionistas.

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics hypervascularization (angioarchitecture) with characteristic arteriographic signs and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers.

Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Interés de la angiografía y procedimientos neurorradiológicos intervencionistas / Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology

El propósito de nuestro estudio es presentar, basándonos en nuestra experiencia y la revisión de la bibliografía realizada, el papel actual de la neurorradiología vascular-intervencionista en el diagnóstico y tratamiento de los paragangliomas de cabeza y cuello (PgCC). El polimorfismo celular de los PgCC les confiere su característica “hipervascularización”(angio arquitectura) con signos arteriográficos patognomónicos y un carácter hemorrágico que justifica su embolización prequirúrgica. Las indicaciones fundamentales de la angiografía digital en los PgCC se establecen para confirmar su diagnóstico y comprender la afectación funcional de los grandes vasos cervicales, así como sus posibles suplencias vasculares. La extensa afectación carotídea o yugular puede hacer inevitable el sacrificio quirúrgico de estos vasos. Son necesarias pruebas funcionales que permitan conocer la permeabilidad del polígono de Willis y/o del seno sigmoide o contralateral para predecir complicaciones neurológicas postratamiento. Aunque el tratamiento de elección de los PgCC es su exéresis completa, la hipervascularización puede hacer complicada la resección quirúrgica. La embolización prequirúrgica es utilizada para facilitar el tratamiento reduciendo la pérdida de sangre, acortando el tiempo quirúrgico y disminuyendo la morbilidad neurológica posquirúrgica. La indicación paliativa de la embolización se establece en casos de tumores inoperables. En la actualidad, se dispone de3 técnicas intervencionistas utilizables en el tratamiento de los PgCC: la embolización endovascular, la punción percutánea directa y la colocación de endoprótesis vasculares. Aunque poco frecuentes, las complicaciones más graves son las relacionadas con el embolismo del material embolizante y, lógicamente, disminuyen en centros sanitarios de alto nivel y con una técnica arteriográfica depurada (AU)

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics “hypervascularization”(angio architecture) with characteristic arteriographicsigns and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers (AU)

[Evolution of Escherichia coli antibiotic resistances in urine samples from the community]. / Evolución de la resistencia a antibióticos de Escherichia coli en muestras de orina procedentes de la comunidad.

OBJECTIVES: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. METHODS: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05) differences in sensitivity comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. RESULTS: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. CONCLUSIONS: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area.

Evolución de la resistencia a antibióticos de Escherichia Coli en muestras de orina procedentes de la Comunidad / Evolution of Escherichia coli antibiotic resistances in urine samples from the community

Objetivo: Los objetivos de este trabajo son dos: primero, evaluar la resistencia a varios antibióticos y las tendencias de la misma en un periodo de seis años en cepas de Escherichia coli aisladas en muestras de orina de pacientes atendidos en Atención Primaria en nuestro medio y, segundo, valorar si las pautas de tratamiento empírico comúnmente aceptadas en nuestro país serían aplicables en nuestro entorno en función de los resultados del estudio. Métodos: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras enviadas desde los diez centros de Atención Primaria del Área Sanitaria de El Bierzo y Laciana (León) entre los años 2002 y 2007. Se determinó la resistencia in vitro de este germen a diversos antibióticos de uso frecuente: fosfomicina, nitrofurantoína, tobramicina, cefuroxima, cefixima, amoxicilina-clavulánico, cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina. Se analizó mediante Chi cuadrado la existencia de diferencias estadísticamente significativas (p < 0,05) de sensibilidad, comparando los años 2002 y 2007 para todos los antimicrobianos excepto para cefixima. En este último caso se compararon los resultados obtenidos en 2002 y 2005. Resultados: Se ha producido un aumento de la resistencia de los aislamientos urinarios de Escherichia coli a todos los antimicrobianos estudiados, menos para la nitrofurantoína, que fue estadísticamente significativo en la mayoría de los casos. Aún así, la resistencia frente a fosfomicina y nitrofurantoína se ha mantenido por debajo del 6% a lo largo del periodo de estudio. Para tobramicina y cefuroxima apenas ha superado el 10% y para cefixima se encuentra por debajo del 3,4%, aunque en este último caso sólo se dispone de datos hasta 2005 en nuestro estudio. La resistencia frente a amoxicilina-clavulánico, inicialmente baja, ha ido aumentando progresivamente hasta alcanzar el 20,6% en 2007. Lo mismo ocurre para cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina, hasta superar el 32% en 2007 en el caso de los tres primeros y el 62% en el último. Conclusiones: La variación en los patrones de resistencia bacteriana de Escherichia coli obliga a disponer de un conocimiento actualizado de los mismos para adaptar las pautas generales de tratamiento empírico a cada área de salud concreta (AU)

Objectives: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. Methods: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05j differences in sensitivity, comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. Results: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. Conclusions: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area (AU)

Síndrome de Ogilvie. Presentación de un caso y revisión de la literatura médica / Olgivie´s syndrome. Case report and literature

Presentamos un caso de dilatación aguda idiopática del colon ­síndrome de Ogilvie­ en un anciano. Es una entidad clínica no infrecuente que se caracteriza por dilatación del intestino grueso, sin obstrucción mecánica, que se asocia normalmente a patología médica grave y al postoperatorio, fundamentalmente de intervenciones obstétricas, ortopédicas y urológicas. El diagnóstico se realiza por la clínica y los estudios radiológicos complementarios. El tratamiento inicialmente es conservador y en ocasiones se realiza colonoscopia y/o cirugía para evitar la complicación más grave que es la perforación del ciego

We present a case of acute idiopathic dilatation of the colon ­Ogilvie's syndrome­ in an elderly patient. This not infrequent clinical entity is characterized by marked dilatation of the colon in the absence of demonstrable intestinal obstruction, and is usually associated with severe medical or surgical disease, especially after obstetric, orthopaedic or urologic surgery. Diagnosis is established by clinical history, physical examination and radiological findings. Management includes medical measures and occasionally endoscopic colonic decompression and/or surgery to avoid perforation of the cecum, the most serious complication

Leiomioma vesical / Bladder leiomyoma. A case report and literature review

OBJETIVO: Aportar un nuevo caso de leiomiomavesical a la literatura española.MÉTODO: Hallazgo casual en un estudio ecográfico pélvicode una tumoración de 20 mm en la cara lateral derechade la vejiga de una mujer de 29 años. El cistogramade la urografía intravenosa mostró la presencia de undefecto de repleción en esa misma localización. Se realizócistoscopia con el hallazgo de una tumoración en lacara lateral derecha de la vejiga, con recubrimiento mucosode aspecto normal.RESULTADO: Con el diagnóstico de sospecha de leiomiomavesical se realizó resección transuretral de la tumoración,con confirmación anatomopatológica de dicho diagnóstico.En el postoperatorio desarrolló una placa calcáreasobre el área de resección previa, que se tratómediante resección transuretral de ésta y de restos leiomiomatososy acidificación urinaria posterior.CONCLUSIÓN: Aunque se trata de un tumor raro, endeterminadas circunstancias es posible establecer el diagnósticoprequirúrgico con un alto índice de sospecha. Porotra parte, dada la benignidad del proceso, la cirugíaconservadora, en esta caso la resección transuretral, ofreceexcelentes resultados

OBJECTIVES: To report a new case of ;;bladder leiomyoma. ;;METHODS: A 20 mm tumor of the right lateral wall of ;;the bladder was incidentally found in a pelvic ultrasound ;;study of a 29-year-old female. The cystogram showed ;;the presence of a filling defect in the same side. ;;Cystoscopy showed a right lateral wall tumor with normal ;;mucosal cover. ;;RESULTS: With the working diagnosis of bladder leiomyoma, ;;transurethral resection of the bladder tumor was performed, ;;and pathology confirmed the diagnosis. ;;Postoperatively, the patient developed a calcareous plaque ;;on the resection area which was treated by transurethral ;;resection of the plaque and leiomyoma remainders and ;;subsequence urine acidification. ;;CONCLUSION: Although it is a rare tumor, in certain ;;circumstances it is possible to establish the working ;;preoperative diagnosis with a high index of suspicion. ;;On the other hand, due to the benign character of the ;;process, conservative surgery (transurethral resection in ;;this case) offers excellent results

[The treatment of bladder endometriosis. Spanish literature review]. / Tratamiento de la endometriosis vesical. Revisión de la literatura española.

OBJECTIVES: To perform a comprehensive, up-to-date review of the treatment of all cases of bladder endometriosis published in Spanish language journals in our country, including those published in non-urological scientific journals. METHODS: We identified 28 cases of bladder endometriosis published in the Spanish literature. The treatment performed in each case has been studied, as well as the treatment of relapses and follow-up after definitive treatment. Age and history of caesarean section were registered. RESULTS: Mean patient age was 35 years, with a median of 34 years and limits of 27 and 48. The history of caesarean section is present in 11 cases (39%). Several therapeutic regiments have been followed. Watchful waiting was only undertaken in one case due to the absence of urinary symptoms. Three patients received medical therapy initially. Only one of them had a favourable response. The other two underwent partial cystectomy and transurethral resection (TUR) respectively due to negative response. Transurethral resection was the most frequently used therapeutic modality; it was performed in 19 patients in addition to the aforementioned case. Bladder endometriosis recurred in 7 cases after TUR. Four of these cases underwent partial cystectomy, one of them laparoscopic, and three a second transurethral resection. Partial cystectomy was the initial therapeutic option in 5 cases. 4 of them were open and 1 laparoscopic. No recurrences have been described after partial cystectomy, including those performed for TUR failures. Mean follow-up was 37 months and median follow-up 12 months, being the limits 3 and 192 months. CONCLUSIONS: To date most published cases of bladder endometriosis appear in urologic journals. The most common therapeutic modality is transurethral resection, carried out in 20 cases (71%). However, it is necessary to inform the patient about the chances of treatment failure after TUR, around 35% after this review. Finally, the reported cases treated by laparoscopic partial cystectomy have been published by gynaecologists.

[Fournier's gangrene secondary to urethral catheterization]. / Gangrena de Fournier secundaria a cateterismo uretral.

OBJECTIVES: We report one case of Fournier's gangrene secondary to urethral catheterization. METHODS: We describe the clinical case, in which the initial cause was identified, and perform a short bibliographic review. RESULTS: Although Fournier's gangrene was initially considered as idiopathic in etiology, currently it is possible to identify the entrance site of the infection. In the present case the insertion of a urethral catheter was the starting mechanism, associated with factors such as diabetes and alcoholism which favour its development. The patient was treated by surgical debridement and partial urethrectomy but finally died. CONCLUSIONS: We want to point out that urethral instrumentation should be done by expert hands due to the severity of possible complications. We should insist in the need of precocious treatment with wide spectrum antibiotics, radical debridement and complete urologic evaluation.

Tratamiento de la endometriosis vesical. Revisión de la literatura española / The treatment of bladder endometriosis. Spanish literature review

OBJETIVO: Análisis actualizado y de conjuntodel tratamiento de todos los casos de endometriosisvesical publicados en revistas en lengua españolaen nuestro país, incluyendo aquéllos aparecidos enrevistas científicas fuera del ámbito urológico.MÉTODOS: Se han localizado 28 casos de endometriosisvesical publicados en la literatura científica enlengua española en nuestro país. Se ha estudiado eltipo de tratamiento aplicado en cada caso, así comoel de la recidiva y el seguimiento después del tratamientodefinitivo, además de la edad y el antecedentede cesárea.RESULTADOS: Las pacientes analizadas presentaronuna edad media de 35 años, con mediana de 34años y límites entre 27 y 48 años. El antecedente decesárea aparece en 11 casos (39%). Se han seguidovarios regímenes terapéuticos. Sólo en un caso se decidióvigilancia por ausencia de clínica urinaria. En trescasos se utilizó inicialmente la terapia médica. Deéstos, sólo uno respondió favorablemente. Los otros dosse siguieron o bien de cistectomía parcial, o bien deresección transuretral, por mala respuesta. La modalidadterapéutica inicial más utilizada fue la reseccióntransuretral, realizada en 19 pacientes, además delcaso citado previamente. La endometriosis vesical recidivóen siete casos tratados por esta vía. De éstos, cuatrofueron sometidos a cistectomía parcial, una de ellaspor vía laparoscópica, y tres a nueva resección transuretral.Se realizó cistectomía parcial como modalidadterapéutica inicial en cinco casos. De éstas, cuatro serealizaron por vía abierta y una laparoscópica. No sehan descrito recidivas tras las cistectomías parciales,incluyendo aquéllas realizadas para el tratamiento delos casos en los que fracasó la resección transuretral. Lamedia de seguimiento ha sido de 37 meses y medianade 12 meses, con límites entre 3 y 192 meses.CONCLUSIONES: Hasta el momento actual la mayoríade los casos publicados de endometriosis vesicalcorresponden a revistas urológicas. La modalidad terapéuticamás común ha sido la resección transuretral,que se utilizó con este fin en 20 casos (71%). No obstante,es necesario informar a la paciente de la probabilidadde fracaso del tratamiento, del 35% según larevisión de este conjunto de casos, con la reseccióntransuretral. Finalmente, los casos tratados mediante cistectomíaparcial laparoscópica en nuestro país hansido publicados por ginecólogos

OBJECTIVES: To perform a comprehensive, up-to-date review of the treatment of all cases of bladder endometriosis published in Spanish language journals in our country, including those published in non-urological scientific journals. METHODS: We identified 28 cases of bladder endometriosis published in the Spanish literature. The treatment performed in each case has been studied, as well as the treatment of relapses and follow-up after definitive treatment. Age and history of caesarean section were registered. RESULTS: Mean patient age was 35 years, with a median of 34 years and limits of 27 and 48. The history of caesarean section is present in 11 cases (39%). Several therapeutic regiments have been followed. Watchful waiting was only undertaken in one case due to the absence of urinary symptoms. Three patients received medical therapy initially. Only one of them had a favourable response. The other two underwent partial cystectomy and transurethral resection (TUR) respectively due to negative response. Transurethral resection was the most frequently used therapeutic modality; it was performed in 19 patients in addition to the aforementioned case. Bladder endometriosis recurred in 7 cases after TUR. Four of these cases underwent partial cystectomy, one of them laparoscopic, and three a second transurethral resection. Partial cystectomy was the initial therapeutic option in 5 cases. 4 of them were open and 1 laparoscopic. No recurrences have been described after partial cystectomy, including those performed for TUR failures. Mean follow-up was 37 months and median follow-up 12 months, being the limits 3 and 192 months. CONCLUSIONS: To date most published cases of bladder endometriosis appear in urologic journals. The most common therapeutic modality is transurethral resection, carried out in 20 cases (71%). However, it is necessary to inform the patient about the chances of treatment failure after TUR, around 35% after this review. Finally, the reported cases treated by laparoscopic partial cystectomy have been published by gynaecologists

Gangrena de Fournier secundaria a cateterismo uretral / Fournier´s gangrene secondary to urethral catheterization

OBJETIVOS: Mediante el formato de casoclínico presentamos un caso de Gangrena de Fourniersecundario a cateterismo uretral.MÉTODOS: Realizamos una descripción del caso clínicoque nos ocupa, en el que se ha identificado la causa inicial,así como una breve revisión bibliográfica de estapatología.RESULTADO: Aunque la gangrena de Fournier se considerabainicialmente como de etiología idiopática, en laactualidad es posible identificar en la mayoría de loscasos la puerta de entrada de la infección. En nuestrocaso la colocación de un catéter uretral fue el mecanismode inicio de la infección, asociado a dos factores como ladiabetes y el alcoholismo que favorecen el desarrollo dela misma. Se trató mediante desbridamiento quirúrgico yse realizó uretrectomía parcial. El paciente fue finalmenteexitus.CONCLUSIONES: Se debe llamar la atención sobre lanecesidad de que la manipulación uretral sea realizadapor manos expertas dada la gravedad de las posiblescomplicaciones.Hay que insistir en la necesidad de un tratamiento precozcon una cobertura de antibióticos de amplio espectro, undesbridamiento radical y una revisión urológica completa

OBJECTIVES: We report one case ofFournier`s gangrene secondary to urethral catheterization.METHODS: We describe the clinical case, in which theinitial cause was identified, and perform a shortbibliographic review.RESULTS: Although Fournier`s gangrene was initiallyconsidered as idiopathic in etiology, currently it ispossible to identify the entrance site of the infection. Inthe present case the insertion of a urethral catheter wasthe starting mechanism, associated with factors such asdiabetes and alcoholism which favour its development.The patient was treated by surgical debridement andpartial urethrectomy but finally died.CONCLUSIONS: We want to point out that urethralinstrumentation should be done by expert hands due tothe severity of possible complications. We should insistin the need of precocious treatment with wide spectrumantibiotics, radical debridement and complete urologicevaluation

[Urinary stone in a Bricker's ileal conduit]. / Litiasis en conducto urinario tipo Bricker.

OBJECTIVES: To report one case of urinary stone as a relatively frequent complications of urinary diversion using bowel loops. METHODS: We perform a short bibliographic review using the case report format. RESULTS: Stone formation in Bricker's type urinary diversion is secondary to various factors such as urinary stasis, bacteriuria, presence of intestinal mucus, metallic sutures, metabolic disturbances, etc. CONCLUSIONS: Periodic control by radiological studies is recommended due to the high frequency of this complication in patients with urinary diversion. Treatment is usually conservative or minimally invasive, being surgery reserved for those cases in which stone extraction is not safe using other methods.