Histerectomía laparoscópica en patología benigna en un hospital universitario terciario. Análisis y evolución de un periodo de 8 años / Laparoscopic hysterectomy for benign pathology in a tertiary university hospital: Analysis and evolution in a period of 8 years

Objetivo: Reflexionar desde el análisis de los datos del número de histerectomías laparoscópicas que puede realizar cada miembro de un servicio de ginecología de un hospital terciario sobre la conveniencia de limitar este procedimiento a un número limitado de profesionales. Material y métodos: Estudio retrospectivo, descriptivo, sobre las histerectomías realizadas por cualquier indicación en nuestro hospital en el periodo comprendido entre el 1 de mayo del año 2014 y el 30 de abril del año 2022. Resultados: En este periodo hemos realizado 1548 histerectomías, de las que 760 se efectuaron por vía laparoscópica; y de ellas, 289 fueron indicadas por patología benigna. Considerando el total de profesionales que conforman el pool de cirujanos que realizan cirugía por patología benigna, la media de histerectomías laparoscópicas por cirujano y año sería de 1,4 casos. Conclusiones: Para garantizar la adecuada calidad de la cirugía, el número de profesionales que realizan histerectomías laparoscópicas en un hospital terciario debe ser limitado.(AU)

Objective: To reflect from the analysis of the data of the number of laparoscopic hysterectomies that each member of a gynaecology service of a tertiary hospital can perform on the convenience of limiting this procedure to a limited number of professionals. Material and methods: Retrospective, descriptive study on hysterectomies performed for any indication in our hospital in the period between May 1, 2014 and April 30, 2022. Results: In this period, we have performed 1548 hysterectomies of which 760 were performed laparoscopically and of these, 289 were indicated for benign pathology. Considering the total number of professionals that make up the pool of surgeons who perform surgery for benign pathology, the average number of laparoscopic hysterectomies per surgeon per year would be 1.4 cases. Conclusions: To ensure adequate quality of surgery, the number of professionals performing laparoscopic hysterectomies in a tertiary hospital should be limited.(AU)

[Translated article] A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyse the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty. / Una revisión sistemática de la literatura: el uso de vainas metafisarias en cirugía de revisión de artroplastia de rodilla.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyze the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

Epidemiology of Bone Fractures in the Hand in Adult Population Using the ICD-10 Classification.

PURPOSE OF THE STUDY The purpose of this study was to conduct an epidemiological study of hand fractures in adult population. MATERIAL AND METHODS A retrospective observational study in a population of 470,000 habitants was performed. Over the course of three years, all patients over 16 years of age who were diagnosed with fracture or fracture-dislocation at the level of a carpal bone, metacarpal and/or phalange were included. These fractures were classified according to the International Classification of Diseases 10th edition (ICD-10). Incidence rates, along with gender and age distribution were also studied. RESULTS 1,267 patients with a total of 1,341 hand fractures were included. They represented 29.7% of all upper limb fractures and 7.6% of all traumatological emergencies involving a bone fracture during that period. The most frequent ICD-10 group was S62.3, with the fifth metacarpal as the most often affected bone (39.7%). The most frequent location at the level of the phalanges (S62.5) was the proximal third of the proximal phalanx of the fifth radius. The global incidence rate was 99 fractures per 100,000 persons/year. No seasonal variation was observed. Only 10.2% of hand fractures received surgical treatment. DISCUSSION Several epidemiological studies have been published on fractures in the hand, but none have used the ICD-10 classification. Although the distribution of our stratified sample by age and gender was similar to those previously published, the incidence rate in our study was much lower. We may possibly extrapolate our results to the rest of the Spanish population and even to the rest of the population of southern Europe, given the scarcity of epidemiological studies on this matter in these geographical areas. CONCLUSIONS The ICD-10 classification is useful for the description and classification of hand fractures. The most often affected group is that including metacarpals of the long fingers (S62.3), being the distal level of the fifth metacarpal in young male patients the most frequent one. Most fractures are treated conservatively and in case of surgical treatment, the preferred surgical techniques include K-wire fixation, interfragmentary compression screws and plate osteosynthesis. Key words: epidemiology, incidence, fracture, fracture dislocation, carpal bones, metacarpals, finger phalanges.

Efficacy and safety of administering oral misoprostol by titration compared to vaginal misoprostol and dinoprostone for cervical ripening and induction of labour: study protocol for a randomised clinical trial.

BACKGROUND: Among the various methods available, the administration of prostaglandins is the most effective for inducing labour in women with an unfavourable cervix. Recent studies have compared treatment with various titrated doses of oral misoprostol with vaginal misoprostol or dinoprostone, indicating that the use of an escalating dose of an oral misoprostol solution is associated with a lower rate of caesarean sections and a better safety profile. The objective of this study is to assess which of these three therapeutic options (oral or vaginal misoprostol or vaginal dinoprostone) achieves the highest rate of vaginal delivery within the first 24 h of drug administration. METHODS: An open-label randomised controlled trial will be conducted in Araba University Hospital (Spain). Women at ≥41 weeks of pregnancy requiring elective induction of labour who meet the selection criteria will be randomly allocated to one of three groups: 1) vaginal dinoprostone (delivered via a controlled-release vaginal insert containing 10 mg of dinoprostone, for up to 24 h); 2) vaginal misoprostol (25 µg of vaginal misoprostol every 4 h up to a maximum of 24 h); and 3) oral misoprostol (titrated doses of 20 to 60 µg of misoprostol following a 3 h on + 1 h off regimen up to a maximum of 24 h). Both intention-to-treat analysis and per-protocol analysis will be performed. DISCUSSION: The proposed study seeks to gather evidence on which of these three therapeutic options achieves the highest rate of vaginal delivery with the best safety profile, to enable obstetricians to use the most effective and safe option for their patients. TRIAL REGISTRATION: NCT02902653 Available at: https://clinicaltrials.gov/show/NCT02902653 (7th September 2016).

The effects of changes to the built environment on the mental health and well-being of adults: Systematic review.

There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.

Domain wall manipulation in magnetic nanotubes induced by electric current pulses.

We propose that the injection of electric currents can be used to independently manipulate the position and chirality of vortex-like domain walls in metallic ferromagnetic nanotubes. We support this proposal upon theoretical and numerical assessment of the magnetization dynamics driven by such currents. We show that proper interplay between the tube geometry, magnitude of the electric current and the duration of a current pulse, can be used to manipulate the position, velocity and chirality of a vortex domain wall. Our calculations suggest that domain wall velocities greater than 1 km s(-1) can be achieved for tube diameters of the order of 30 nm and increasing with it. We also find that the transition from steady to precessional domain wall motion occurs for very high electric current densities, of the order of 10(13) A m(-2). Furthermore, the great stability displayed by such chiral magnetic configurations, and the reduced Ohmic loses provided by the current pulses, lead to highly reproducible and efficient domain wall reversal mechanisms.

Estimulación eléctrica medular / No disponible

No disponible

Generalización de la fiabilidad: un enfoque metaanalítico aplicado a la fiabilidad / Reliability generalization: A meta-analytic approach to reliability coefficients

La fiabilidad no es una propiedad inherente al test, por lo que frases del tipo “la fiabilidad del test es de 0,80” son incorrectas. Ello se debe a que la fiabilidad es una propiedad de las puntuaciones obtenidas por un test en una aplicación concreta de éste. La generalización de la fiabilidad (GF) es un nuevo tipo de metaanálisis que permite examinar empíricamente la variabilidad de las estimaciones de la fiabilidad en diferentes aplicaciones de un test. Los estudios de GF están poniendo en evidencia lo inadecuado que resulta esa práctica habitual de los investigadores de inducir la fiabilidad a partir de estimaciones previas de ésta. En este artículo se presenta una panorámica del enfoque de GF, describiendo cuáles son sus fases de realización. Además, se discuten algunos de los problemas estadísticos más importantes de los estudios GF, tales como: a) procedimientos de transformación de los coeficientes de fiabilidad; b) métodos de ponderación de los coeficientes, y c) modelos estadísticos asumibles (AU)

Reliability is not a property inherent to the test, so that sentences such as “the test reliability is 0.80” are wrong. That is because reliability is a property of scores obtained in a given application o a test. Reliability generalization (RG) is a new kind of meta-analysis which enables to empirically examine the variability of the reliability estimates across different applications of a test. The RG studies are evidencing how unadvisable is the usual practice of researchers of inducing reliability from previous estimates. In this article an overview of the RG approach is presented, describing the required steps. Moreover, some of the most important statistical issues concerning RG studies are discussed, such as: (a) transforming procedures of the reliability coefficients, (b) weighting methods of the coefficients, and (c) statistical models that can be assumed (AU)

Dolor y déficits neurológicos tras procedimientos anestésicos espinales / No disponible

No disponible

El metaanálisis en el ámbito de las Ciencias de la Salud: una metodología imprescindible para la eficiente acumulación del conocimiento / Meta-analysis in the Health Sciences: an indispensable methodology for the efficient accumulation of knowledge

El metaanálisis es una metodología para la revisión sistemática y cuantitativa de la investigación, ampliamente consolidada y aplicada en las Ciencias de la Salud. Ofrece las técnicas necesarias para acumular rigurosa y eficientemente los resultados cuantitativos de los estudios empíricos sobre un mismo problema de salud, permitiendo a los profesionales de la salud la adopción de decisiones bien informadas en sus respectivas áreas de trabajo. Con la ayuda de algunos ejemplos tomados del ámbito de la Fisioterapia, en este artículo describimos las principales características del metaanálisis, sus fases de ejecución y su utilidad en la investigación sanitaria. Finalmente, se muestran la relevancia del metaanálisis dentro del enfoque de la medicina basada en la evidencia y algunas perspectivas de futuro del metaanálisis(AU)

Meta-analysis is a methodology for the systematic and quantitative review of research that is widely consolidated and applied in Health Sciences. It offers the necessary techniques to rigorously and efficiently accumulate quantitative results on the empirical studies regarding a common health problem. It allows health care professionals to make well-informed decisions in their respective areas. In this article and with the help of some examples obtained from within the physiotherapy setting, we have described the main characteristics of meta-analysis, its execution phases and its usefulness in health care research. The relevance of meta-analysis in the evidence based medicine approach and some perspectives on the future of meta-analysis are shown(AU)

[Maternal and perinatal data of hypospadic in a 25 year period]. / Análisis de los datos maternos y perinatales en pacientes con hipospadias en un periodo de 25 años.

OBJECTIVE: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. MATERIAL AND METHODS: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. RESULTS: There were 9% of proximal hypospadias, 13.6% middle hypospadias, and 77.5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p < 0.001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. CONCLUSIONS: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias.

Análisis de los datos maternos y perinatales en pacientes con hipospadias en un periodo de 25 años / Maternal and perinatal data of hypospadic in a 25 year period

Introducción: El objetivo del estudio es definir los factores de riesgo materno-fetales que pueden influir en la aparición de hipospadias al nacimiento y en la gravedad del mismo. Material y Métodos: Se han recogido los datos de 614 recién nacidos con hipospadias operados en nuestra comunidad en los últimos 25 años (1972-1998). Para su estudio se han dividido en tres grupos de gravedad de la malformación (proximales, medios y distales) y en dos periodos de tiempo, antes y después de 1980, analizándolos en función de los posibles factores predisponentes. Resultados: El 9% presentaban hipospadias proximales, un 13,6% medios y un 77,5% distales. Se ha encontrado una relación estadísticamente significativa entre la gravedad del hipospadias y el bajo peso al nacimiento, retraso en el crecimiento intrauterino, prematuridad y existencia de malformaciones asociadas (p<0,001). No se ha encontrado significación estadística entre la gravedad del hipospadias y la edad materna, hábitos tóxicos, existencia de enfermedades o exposición a radiaciones en el embarazo. A partir del año 1980, los pacientes presentan hipospadias más severos y una edad gestacional menor. Conclusiones: Existen ciertos acontecimientos en el embarazo que pueden favorecer el desarrollo de hipospadias en el feto. Se esta produciendo un incremento en el número de pacientes con hipospadias y gravedad de estos desde 1980

Objective: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. Material and Methods: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. Results: There were 9% of proximal hypospadias, 13,6% middle hypospadias, and 77,5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p<0,001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. Conclusions: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias

La estimulación eléctrica del sistema nervioso central con finalidad analgésica / The electrical stimulation of the central nervous system for pain control

Esta revisión pretende orientar al lector sobre los procedimientos empleados para el control del dolor crónico, preferentemente neuropático, por medio de la electricidad. Historia de la utilización de la electricidad con finalidad analgésica, con descripción de los usos primitivos en el siglo XVIII y su evolución. Estimulación eléctrica medular: Se describen los mecanismos de acción, la selección de los pacientes, las técnicas de implante, la forma de realización de los diferentes procedimientos y sus complicaciones y el manejo de las mismas. Estimulación cerebral: Se sigue el mismo esquema que en el apartado anterior, diferenciándose en dos apartados: la estimulación cerebral profunda y la estimulación de la corteza prefrontal (AU)

Different procedures using electricity for pain control (mainly neuropathic) are described in this review. History of the so-called utility of electricity for pain control, describing the early attempts at the XVIII century and their evolution. Spinal cord stimulation: How does it works, patient’s selection, implant techniques, how to do the different procedures and complications and their management are described. Brain stimulation: The same scheme as above, concerning both Deep Brain Stimulation and Motor Cortex Stimulation (AU)

[The treatment of intradural arteriovenous fistulas in the spine: two case reports]. / Tratamiento de fístulas arteriovenosas intradurales dorsales medulares: presentación de dos casos.

INTRODUCTION: Spinal dural arteriovenous fistulas (AVFs) frequently cause progressive myelopathy. Although endovascular approaches to spinal cord vascular malformations become an important adjunct or primary treatment of theses disorders, surgery can be safely performing in some categories. CASE REPORTS: Two males patients presented with progressively myelopathy two months and three years before, were diagnosed by typical MRI findings and spinal selective arteriograms of dorsal AVFs with single feeder of Spetzler's modified classification of spinal cord vascular lesions. After an attempt of embolization following diagnostic angiography in first case, surgical approach for clipping the afferent single feeder was done for both. CONCLUSIONS: Early recognition by selective diagnostic spinal angiography in patients with slowly progressive and fluctuating myelopathy, allow us surgery as recommended treatment in AVFs, so can effect a better outcome and often reverse presenting neurologic deficits.

[Modified technique for transurethral resection of the prostate with suprapubic drainage and local anesthesia]. / Técnica modificada para la resección transuretral de próstata con drenaje suprapúbico y anestesia local.

PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in elderly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21.9%), and 25 patients were ASA IV (78.1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 occasional pain. In the latter three patients, intravenous sedation was enhanced with 0.1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments.

Topiramato y dolor neuropático / Topiramate and neuropathic pain

No disponible

Dolor en pie de origen simpático / Pain in the foot by sympathetic disorders

No disponible

Determination of lumbar muscular activity in helicopter pilots: a new approach.

BACKGROUND: Discomfort in the lumbar region is a frequent complaint of helicopter pilots. Two factors that helicopter crewmembers relate to back pain are exposure to vibration and poor posture during flight, because during flight the seat and controls force the pilot to adopt an asymmetric posture. Repeated exposure to these adverse flight conditions could cause pathological changes in the spine. The purpose of this study was to compare right and left sided lumbar muscular activity in helicopter pilots under real flight conditions, using surface electromyography (SEMG) to demonstrate the effects of asymmetrical posture on the musculoskeletal system. An attempt was also made to correlate lumbar muscular activity with environmental factors and such variables as type of flight, type of helicopter, duration of flight, age, physical fitness, and height. METHODS: Right- and left-sided lumbar electrical activity were measured using two-channel SEMG during 35 flights in 2 types of helicopter and a cockpit mock-up. RESULTS: There was a statistically significant increase in right-sided lumbar activity when related to the duration of flight. CONCLUSIONS: The data showed that when the pilot used the manual controls during flight, he did not maintain a symmetrical posture and contracted one side more than the other. We think the relationship between the greatest right-sided contraction and flight duration is due to maintaining an asymmetric posture over a long period. We also noted a tendency towards greater right lumbar musculature activity in older pilots.