Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three-dimensional funnel mesh.

AIM: A prophylactic three-dimensional (3D) funnel mesh using the keyhole technique (intraperitoneal onlay mesh position) in abdominoperineal excision (APR) may significantly decrease the parastomal hernia (PSH) index without increasing morbidity. The aim of this retrospective observational study was to analyse the incidence of PSH and postoperative complications in patients who underwent permanent colostomy with the use of a prophylactic 3D preformed mesh compared with patients without a mesh. METHOD: Patients who underwent an end-colostomy after APR for primary or recurrent rectal cancer in a colorectal surgery unit were divided into two groups: group 1 without a prophylactic mesh and group 2 with a prophylactic synthetic mesh. The main end-point was to analyse the incidence of PSH after a median follow-up of 2.8 years. RESULTS: One hundred and ten patients (64 in group 1 and 46 in group 2, without significant clinical differences) underwent a permanent colostomy after APR. In group 1 70.3% developed a PSH, compared with 13% in group 2 (P < 0.001). Age (especially for patients ≥ 75 years) represented a significant risk factor for PSH. There were no differences in postoperative complications between the groups. CONCLUSION: A prophylactic parastomal 3D mesh using the keyhole technique may reduce the incidence of PSH after permanent colostomy without an increase in postoperative complications.

Tratamiento de la trombosis venosa profunda asociada a agenesia de vena cava inferior. Revisión de las anomalías de vena cava inferior / Treatment of deep venous thrombosis associated with inferior vena cava agenesis. A review of inferior vena cava variants

La complejidad de la embriología de la vena cava inferior, con numerosas anastomosis entre pares de venas, puede conducir a multitud de variantes anatómicas. En la población general la agenesia de la vena cava inferior constituye una malformación poco frecuente (0,07%), pero su presencia representa el 5-9,5% de las trombosis venosas profundas idiopáticas en pacientes menores de 30 años y su tratamiento continúa siendo un tema controvertido(AU)

The development of the inferior vena cava is a complex embryological process, with numerous anastomoses among pairs of veins, which may result in many anatomic variants. In the general population, the absence of inferior vena cava is a rare anomaly (0.07%), but this represents 5-9.5% of idiopathic deep venous thrombosis in patients under 30 years-old and its treatment options remain (AU)

Actualización en anemia y terapia transfusional / Anemia and transfusion therapy: an update

La anemia representa una de las patologías más prevalentes en la población general y constituye una entidad extremadamente frecuente en pacientes médicos y quirúrgicos de todas las especialidades. Una correcta valoración de su impacto y de las posibilidades terapéuticas resulta crucial. La transfusión de sangre alogénica representa una medida eficaz en el manejo de la anemia, pero no está exenta de importantes complicaciones. Es responsabilidad del clínico conocer y sopesar todas las alternativas disponibles para el manejo global de la anemia. Transfusiones sanguíneas, agentes estimuladores de la eritropoyesis, ferroterapia (oral y endovenosa) y otras alternativas terapéuticas han de ser empleadas de forma racional y ajustándonos a la evidencia clínica disponible hasta la fecha. El presente artículo de revisión resume algunas características epidemiológicas de la anemia, su valoración clínica y las principales alternativas terapéuticas a la luz de los conocimientos actuales, con especial énfasis en el paciente crítico (AU)

Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient (AU)

[Anemia and transfusion therapy: an update]. / Actualización en anemia y terapia transfusional.

Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient.

[Contrast nephropathy. Review and prophylaxis]. / Nefropatía por contraste. Revisión y profilaxis.

The use of diagnostic techniques with iodinated contrast media represents a regular medical practice. Contrast induced nephropathy is a rare complication in the general population but it has an important prevalence and morbidity in selective groups of patients. Its multifactorial pathogenesis has not yet been totally determined. Identification of high-risk patients and early application of suitable preventive measures is crucial. The following article summarizes the most important aspects of this entity and the possibilities for its prevention.

Nefropatía por contraste. Revisión y profilaxis / Contrast nephropathy. Review and prophylaxis

La realización de pruebas diagnósticas concontrastes yodados representa una práctica habitualen medicina. La nefropatía por contraste constituyeuna complicación poco frecuente en la poblacióngeneral pero con importante prevalencia ymorbilidad en determinados grupos de pacientes. Supatogenia multifactorial no ha sido aúncompletamente esclarecida. La identificación de losenfermos con factores de riesgo y la aplicaciónprecoz de las oportunas medidas preventivas resultacrucial. El siguiente artículo resume los aspectosmás destacados de esta entidad y las posiblesestrategias profilácticas

The use of diagnostic techniques with iodinated contrastmedia represents a regular medical practice.Contrast induced nephropathy is a rare complicationin the general population but it has an importantprevalence and morbidity in selective groups ofpatients. Its multifactorial pathogenesis has not yetbeen totally determined. Identification of high-riskpatients and early application of suitable preventivemeasures is crucial. The following article summarizesthe most important aspects of this entity and the possibilities for its prevention (AU)

Administración intraoperatoria selectiva de azul de metileno en hemorragia digestiva baja grave secundaria a divertículo yeyunal complicado / No disponible

No disponible

Síndrome compartimental abdominal en el postoperatorio de un paciente con aneurisma de aorta abdominal infrarrenal fisurado. Caso clínico y revisión de la bibliografía / Abdominal compartment syndrome in the post-operative period in a patient with a fissured aneurysm in the infrarenal abdominal aorta. A case report and review of the literature

Introducción. El síndrome compartimental abdominal (SCA) representa una entidad clínica caracterizada por un aumento de la presión intraabdominal con potencial para provocar, si no se diagnostica y se corrige a tiempo, fallo multiorgánico progresivo y la muerte del paciente. En nuestra especialidad, el paradigma sería los enfermos con un aneurisma de aorta abdominal fisurado y tratados tanto con cirugía abierta convencional, como mediante técnicas endovasculares. Caso clínico. Varón de 79 años con factores de riesgo vascular habituales, que acudió a Urgencias por un cuadro de dolor lumbar con masa abdominal pulsátil en la exploración. Tras la realización de una tomografía axial computarizada, que confirmó el diagnóstico y descartó la terapéutica endovascular, fue intervenido mediante cirugía abierta, en la que se realizó una exclusión del aneurisma y una derivación aortobifemoral. En el postoperatorio precoz presentó deterioro clínico progresivo, oligoanuria y distensión abdominal grave por lo que, tras descartar otras causas de fallo multiorgánico, se realizó medición de la presión intravesical ante la sospecha de posible SCA. Tras confirmar la situación de hiperpresión intraabdominal fue reintervenido para realizar una laparotomía descompresiva. En la revisión de la bibliografía se discute la fisiopatología, los métodos diagnósticos y el tratamiento del SCA. Conclusión. Existe un grupo de pacientes en los que la identificación de las situaciones de riesgo de desarrollar un SCA resulta vital para evitar, mediante una intervención precoz, un desenlace fatal hacia el fallo multiorgánico y el fallecimiento

Introduction. Abdominal compartment syndrome (ACS) is a clinical entity characterised by an increase in the intra-abdominal pressure which can potentially lead to progressive multiple organ failure and the death of the patient, if it is not diagnosed and corrected in time. In our speciality, the paradigm would be patients with a fissured abdominal aortic aneurysm who have been treated with both conventional open surgery and by means of endovascular techniques. Case report. A 79-year-old male with the usual vascular risk factors, who visited the Emergency Department because of symptoms consisting in lower back pain and an abdominal pulsatile mass that was found in the examination. Following a computerised axial tomography scan, which confirmed the diagnosis and precluded the possibility of endovascular therapy, the patient was submitted to open surgery, which involved exclusion of the aneurysm and an aortobifemoral bypass. During the early phase of the post-operative period the patient showed progressive clinical deterioration, oligoanuria and severe abdominal distension. In consequence, after ruling out other causes of multiple organ failure and with the suspicion of possible ACS, the intravesical pressure was measured. After confirming the existence of high pressure within the abdomen, a second operation was performed to carry out a decompressive laparotomy. In the review of the literature, the pathophysiology, diagnostic methods and treatment of ACS are discussed. Conclusions. There is a group of patients in whom the identification of situations of higher risk of developing ACS is essential so that an early intervention can prevent a fatal outcome that leads to multiple organ failure and death

Síndrome de Body Packer por intoxicación por cocaína / “Body Packer” syndrome due to cocaine intoxication

No disponible