Toolkit para la creación de unidades de úlcera de pie diabético / A toolkit to create diabetic foot ulcer units

Bajo el nombre de «Toolkit para unidades de úlcera de pie diabético» se han diseñado un conjunto de herramientas para facilitar la puesta en marcha, el funcionamiento y la evaluación de este tipo de unidades clínicas. El Toolkit ha sido realizado por 6 cirujanos vasculares y 2 metodólogos, y para su elaboración se han consultado las principales guías de práctica clínica en el manejo del pie diabético. El Toolkit incluye material destinado a atención primaria y otras especialidades fuera del ámbito de la cirugía vascular (conceptos básicos, algoritmos de manejo, recomendaciones de prevención primaria y criterios de derivación a cirugía vascular), y material para el propio servicio de cirugía vascular (recomendaciones sobre los recursos necesarios para montar una unidad de úlcera de pie diabético, algoritmos clínicos de manejo, cuadernos de recogida de datos, base de datos en Microsoft Access y herramientas de evaluación clínica y económica de la unidad) (AU)

Under the name of «The Diabetic Foot Ulcer Units Toolkit» we have designed a set of tools as an aid for the implementation, performance and evaluation of these Clinical Units. The Toolkit has been prepared by 6 vascular surgeons and 2 experts in methodology. Major clinical practice guidelines in the management of diabetic foot were consulted. The Toolkit includes tools for primary care and other specialties outside the field of vascular surgery (basic concepts, criteria for referral to DFUU, initial basic tests and recommendations for clinical management and primary prevention), and tools for vascular surgery service (list of optimal resources for the DFUU implementation, clinical management algorithms, data collection forms, Microsoft Access database, and tools for the clinical and economical evaluation) (AU)

Aneurismas de la vena esplénica. A propósito de un caso y revisión de la literatura / Aneurysms of splenic vein. A case report and review of the literature

Los aneurismas de vena esplénica son extremadamente raros y habitualmente secundarios a hipertensión portal. Suelen ser asintomáticos, si bien pueden debutar con trombosis, rotura o dolor abdominal. En cuanto al diagnóstico, generalmente se trata de un hallazgo casual tras exploraciones tales como eco-Doppler color, TAC abdominal o fase venosa de una arteriografía abdominal. El tratamiento puede variar desde el seguimiento no invasivo a la escisión quirúrgica. Presentamos un caso de una mujer de 50 años con un aneurisma de vena esplénica de 5 cm de diámetro, sin antecedentes de hipertensión portal y cuyo tratamiento fue la extirpación quirúrgica (AU)

Single-stage laparoscopic and endoscopic treatment for choledocholithiasis: a novel approach.

The transcystic approach is ideal for the management of choledocholithiasis detected during the course of laparoscopic cholecystectomy. When this approach is not possible or fails, current alternatives include laparoscopic choledochotomy, conversion to open common bile duct exploration, or postoperative endoscopic sphincterotomy (ES). Intraoperative ES is not routinely advised, as it is thought to be difficult to carry out in the operating room with the patient in the supine position. We challenged this concept and have performed ES intraoperatively when the transcystic approach had failed. Five consecutive patients in whom transcystic extraction of choledocholiths had failed underwent intraoperative ES. The laparoscopic procedure was terminated, the trocars were removed, the wounds were closed, and the patients were placed in the left lateral decubitus position. In this position, the endoscope was inserted, ES was performed under fluoroscopic guidance, and choledocholithiasis was treated. There were no difficulties or complications, and the postoperative course was similar to that of a simple laparoscopic cholecystectomy in all five patients. Intraoperative ES is a viable and effective treatment for choledocholithiasis when the transcystic approach fails. This novel approach to choledocholithiasis is well tolerated and may save the extra time and effort associated with all other current alternatives.