Impact of timing of dental implant placement and loading: Summary and consensus statements of group 1-The 6th EAO Consensus Conference 2021.

OBJECTIVES: This publication reports on the EAO workshop group 1 summaries, discussions and consensus statements based on four systematic reviews evaluating the impact of timing of dental implant placement and loading. MATERIALS AND METHODS: The first of the systematic reviews was on the influence of the timing of implant placement and loading in the biological outcomes of implant-supported fixed partial dentures. The second systematic review evaluated the influence of the timing of implant placement and loading on the aesthetic outcomes in single-tooth implants. The third systematic review was on the long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading and the fourth on patient's perception of timing concepts in implant dentistry. The group evaluated these systematic reviews, provided comments and additions as required and agreed on the relevant consensus statements as well as on clinical and research recommendations. RESULTS: Different timings of implant placement/loading presented with high implant survival rates. The systematic reviews evaluated from this working group provided a number of conclusions based on the available/current literature. However, the specific topic of timing is an area that further research is required in order to provide detailed guidelines for the different protocols to be employed.

Occurrence and fate of pharmaceuticals in a wastewater treatment plant from southeast of Spain and risk assessment.

Pharmaceutical and personal care products (PPCPs) can be incorporated into ecosystems and pose potential environmental and health hazards. These pollutants are becoming omnipresent in the environment because they are introduced by several sources, being particularly important the contribution of human-derived pharmaceuticals. The presence of PPCPs in waters has received increasing attention in recent years, resulting in great concern regarding their occurrence, transformation, fate and environmental risk. For that reason, the pharmaceuticals carbamazepine (CBZ), diclofenac (DIC), ibuprofen (IBU), ketoprofen (KET) and naproxen (NPX) were measured in the waters and sludge of several parts of a double step activated sludge wastewater treatment plant (WWTP) from Murcia (Spain). With these results, the biological degradation constant, the sorption coefficient and the pharmaceutical removal were calculated. Possible risks to humans and ecosystems were also evaluated. These showed good degradation of IBU and NPX (74.4 and 84.9%, respectively), while CBZ didn't display any degradation. DIC was the compound most likely to be sorbed into the sludge (3.09 L kg-1). The PPCPs removal in this double stage WWTP was compared to a previous data obtained in a WWTP of the same region with an activated sludge (single biological batch reactor). The results showed a decrease in the removal of the double stage plant, probably due to the lower hydraulic retention time employed. The study of the human and ecological risk quotients indicates a low risk of the selected pharmaceuticals (RQ < 0.1).

Association between Burnout Syndrome and medical training by specialty in first-year residents / Síndrome de burnout en residentes de primer año: asociación por especialidad

Abstract Introduction Burnout syndrome (BOS) comprises emotional exhaustion, depersonalization, and reduced personal accomplishment in those affected. Instruments such as the Maslach Burnout Inventory (MBI) can help to identify those affected. Physicians in training have been described as an at-risk group for this syndrome. Objective Describe the association between BOS and medical training by specialty in first-year residents. Method This is a cross-sectional analytical study of specialty residents at the Hospital Civil de Guadalajara. Sociodemographic data were obtained and the MBI was administered to identify BOS. Samples were compared, and a comparative analysis performed to identify factors associated with BOS. Results Eighty-eight residents were included, with 21.6% (n = 19) presenting BOS, 53.4% displaying emotional exhaustion (n = 47), 53.7% showing depersonalization (n = 47), and 39.8% reduced personal accomplishment (n = 35). Presenting BOS was not associated with sociodemographic characteristics or type of specialty. Work hours (ro = .229, p = .032), and a higher number of on-call hours/week (ro = .34, p = .001) were associated with higher BOS. Discussion and conclusion The prevalence of BOS was lower than expected. Over half scored for emotional exhaustion and depersonalization, which could be explained by a self-reporting bias. There was no association between the group/type of specialty and BOS. This study creates new knowledge that works as an institutional situational diagnosis, helps to determine the scope of the problem, and encourages to consider the contributing factors to its origin and maintenance.

Resumen Introducción El síndrome de burnout (SBO) comprende el agotamiento emocional, la despersonalización y la reducción de la realización personal en aquellos a quienes afecta. Instrumentos como el Maslach Burnout Inventory (MBI) pueden ayudar a identificar a los afectados. Los médicos en formación se han descrito como un grupo de riesgo para presentar este síndrome. Objetivo Describir la asociación entre el síndrome de burnout y la formación médica por especialidad en residentes de primer año. Método Se trata de un estudio analítico transversal de residentes de especialidad del Hospital Civil de Guadalajara. Se obtuvieron datos sociodemográficos y se administró el MBI para identificar SBO. Se compararon las muestras y se realizó un análisis comparativo para identificar los factores asociados con SBO. Resultados Se incluyeron 88 residentes, con 21.6% (n = 19) presentando SBO; 53.4% mostrando agotamiento emocional (n = 47); 53.7% (n = 47) mostrando despersonalización; y 39.8% (n = 35) reducción de realización personal. La presentación de SBO no se asoció a características sociodemográficas ni al tipo de especialidad. Las horas de trabajo (ro = .229, p = .032) y un mayor número de horas de guardia/semana (ro = .34, p = .001) se asociaron con una mayor BOS. Discusión y conclusión La prevalencia de SBO fue menor de lo esperado. Más de la mitad puntuó por agotamiento emocional y despersonalización, lo que podría explicarse por un sesgo en la autoevaluación. No hubo asociación entre el grupo/tipo de especialidad y SBO. Este estudio genera nuevos conocimientos que funcionan como un diagnóstico situacional institucional, ayuda a determinar el alcance del problema y alienta a considerar los factores que contribuyen a su origen y mantenimiento.

Drugs and diseases: Summary and consensus statements of group 1. The 5th EAO Consensus Conference 2018.

OBJECTIVES: The task of this working group was to update the knowledge about the use of drugs and biologicals affecting healing of soft tissue and bone during implant treatment or procedures associated with it. Moreover, the impact of titanium particles and biocorrosion on complications and implant survival has been analysed. MATERIALS AND METHODS: The literature in the areas of interest (platelet concentrates, antiresorptive drugs as well as implant-host interaction) was screened using systematic reviews for the former two areas, whereas a narrative critical review was performed for the latter topic. Two manuscripts on platelet concentrates, one manuscript on antiresorptive drugs and one manuscript on the effects of biocorrosion, were presented for group analysis with subsequent discussion in the plenum and final consensus approval. RESULTS: Results and conclusions of the individual reviews of the three topics are presented in the respective papers. Conclusions of the group on strengths and weaknesses of available evidence as well as consensus statements and directions for further research are provided in this study. The following papers were subject to group discussions and formed the basis for the consensus statements: Stähli A, Strauss FJ, Gruber R. () The use of platelet-rich-plasma to enhance the outcomes of implant-related therapies: a systematic review Strauss FJ, Stähli A, Gruber R. (2018) The use of platelet-rich-fibrin to enhance the outcomes of implant-related therapies: a systematic review Mombelli A, Hashim D, Cionca N. () What is the impact of titanium particles and bio-corrosion on implant survival and complications? A critical review Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Morten Schiødt, Klinge B. () The effect of antiresorptive drugs on implant therapy: a systematic review.

Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana / Initial results of the oesophageal and gastric cancer registry from the Comunidad Valenciana

Objetivos: Evaluar los resultados iniciales del registro de tumores esófago-gástricos desarrollado conjuntamente por la Sociedad Valenciana de Cirugía y la Consellería de Sanitat de la Comunidad Valenciana. Métodos: Participaron 14 de los 24 hospitales públicos de la Comunidad Valenciana. Se evaluaron todos los pacientes con diagnóstico de carcinoma de esófago y de estómago operados desde enero 2013 hasta diciembre 2014. Se analizaron variables demográficas, clínicas e histopatológicas. Resultados: Se incluyeron 434 pacientes, 120 con carcinoma de esófago y 314 con carcinoma gástrico. Solo en 2 centros se operaron a más de 10 pacientes con cáncer de esófago/año. La esofaguectomía transtorácica fue el abordaje más frecuente (84,2%) en los tumores de localización esofágica. En el 50,9% de los carcinomas de la unión esófago-gástrica (UEG) se realizó una gastrectomía total. La mortalidad postoperatoria a los 30 y 90 días fue del 8 y 11,6% en el carcinoma de esófago y del 5,9 y 8,6% en el carcinoma gástrico. Antes de la cirugía, los tumores esofágicos del tercio medio fueron tratados mayoritariamente (76,5%) con quimiorradioterapia. Por el contrario, los de tercio inferior y los de la UEG fueron tratados preferentemente solo con quimioterapia (45,5 y 53,4%). El 73,6% de los pacientes con carcinoma gástrico no recibió tratamiento neoadyuvante. La mitad de los pacientes con carcinoma esofágico o gástrico no recibió ningún tratamiento adyuvante. Conclusiones: Este registro muestra que en la Comunidad Valenciana, la mitad de los pacientes con cáncer de esófago son operados en hospitales con una casuística menor de 10 casos/año. Asimismo, ha detectado posibilidades de mejora relevantes en indicadores de resultado de los carcinomas esófago-gástricos (AU)

Aims: To evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). Methods: Fourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. Results: Four hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma. Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. Conclusions: This registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas (AU)

Initial results of the oesophageal and gastric cancer registry from the Comunidad Valenciana. / Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana.

AIMS: To evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). METHODS: Fourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. RESULTS: Four hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma. Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. CONCLUSIONS: This registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas.

Inflammasome as a Key Pathogenic Mechanism in Endometriosis.

BACKGROUND: Endometriosis remains a challenging condition for clinicians to treat. To improve our results, we have to develop new treatment strategies based on pathophysiological mechanisms targeting the etiologic and pathogenic processes involved. OBJECTIVES: Revise new inflammatory pathogenic mechanisms involved in endometriosis, namely inflammasome. METHOD: Literature review for the updating of data to give new clues for different options of treatments. RESULTS: Inflammasome has been described as a multiprotein complex and is considered a key regulator of the innate and adaptive host response that surveys the cytosol and other compartments into the cell. It is involved in the immediate detection and responds to the presence of danger- and pathogen-associated molecular patterns named DAMPs and PAMPs respectively, and has been described in several cells, mainly on immune cells of the myeloid lineage and epithelial cells in tissues with mucosal surfaces. Four inflammasome are formed in a stimulus-dependent manner of distinct composition. They are the Noll Like Receptors (NLR) proteins Nlrp1b, Nlrp3, Nlrc4, and Nlrp6, as well as the absent in melanoma 2 (AIM2). They activate the production of IL-1ß and IL-18 that induce a host response such as pyroptosis, a proinflammatory cell death and the secretion of leaderless cytokines and growth factors. Inflammasome is linked to atherosclerosis, periodic fever syndromes, vitiligo, Crohn's disease, gout, asbestosis, silicosis, Alzheimer's disease and periodontitis. Endometriosis has been related with IL-1ß and Another NLR, Nlrp7, was correlated with myometrial invasion in human endometrial cancer tissue. CONCLUSIONS: These new clues regarding the pathogenic mechanisms involving the inflammasome may be crucial in the future development for endometriosis therapy.

The patient undergoing implant therapy. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

INTRODUCTION: The assignment for this working group was to update the existing knowledge regarding factors considered being of special relevance for the patient undergoing implant therapy. This included areas where conflicting opinions exists since long or recently has been expressed, like the role of antibiotic prophylaxis in dental implant surgery and peri-implantitis. Also areas with growing interest and concern such as patient-reported outcome measures (PROMs) and health-economy was included in this review. MATERIALS AND METHODS: The literature in the respective areas of interest (antibiotic prophylaxis, peri-implantitis, patient-reported outcome measurements and health-economic aspects) was searched using different strategies for the different papers. Search strategies ranged from a complex systematic review to systematic- and narrative reviews, depending on subject and available literature. All collected material was critically reviewed. Four manuscripts were subsequently presented for group analysis and discussion and plenum discussions and concensus approval. The selected areas were considered to be of key importance and relevance for the patient undergoing implant therapy. RESULTS: The results and conclusions of the review process are presented in the respective papers. The group's conclusions, identified knowledge gaps, directions for future research and concensus statements are presented in this article. The following reviews were available for group discussions and the foundation for subsequent plenary sessions: Lund B, Hultin M, Tranaeus S, Naimi-Akbar A, Klinge B. (2015) Perioperative antibiotics in conjunction with dental implant placement. A complex systematic review. Renvert S & Quirynen M. (2015) Risk indicators for peri-implantitis. A narrative review. De Bruyn H, Raes S, Matthys C, Cosyn J. (2015) The current use of patient centered/reported outcomes in implant dentistry. A systematic review. Beikler T & Flemmig T.F. (2015) Economic evaluation of implant-supported prostheses. A narrative review.

[Neuroticism and post-traumatic stress disorder: a meta-analytic study]. / Neuroticismo y trastorno por estrés postraumático: un estudio meta-analítico.

BACKGROUND: There are conflicting results on the role of neuroticism as a risk factor for post-traumatic stress disorder (PTSD). The objectives of this study were to estimate the magnitude and direction of the association between neuroticism and PTSD, and to analyze the influence of different moderator variables on effect size. METHODS: A systematic review and a meta-analysis were carried out. The search for studies was conducted in Medline, IME, PsycINFO, Trip Database, and Google Scholar, until October 2012. A hand search was also carried out and main researchers were contacted. INCLUSION CRITERIA: (a) empirical studies of the association between neuroticism and PTSD using validated scales or diagnostic criteria (DSM, ICD), (b) in participants exposed to a traumatic event and (c) written in English or Spanish. Two independent evaluators performed the selection and extracted the data following a previously developed protocol. The random-effects model was applied to obtain the mean effect size and to explore moderators. RESULTS: Out of 96 potential articles, 34 fulfilled the inclusion criteria (9,941 participants). The mean effect size was r+ = 0.371 (95%CI: 0.327 and 0.414). Publication bias was discarded as a threat. A predictive model was elaborated with three variables (reporting of ethnicity, age, and type of sample). CONCLUSION: Neuroticism can be considered as a risk factor for PTSD in people who have been exposed to a traumatic event. These findings are relevant for developing preventive interventions and treatments.

Neuroticismo y trastorno por estrés postraumático: un estudio metaanalítico / Neuroticism and post traumatic stress disorder: a metaanalytic study

Fundamentos: Existen resultados contradictorios sobre el papel del neuroticismo como factor de riesgo del trastorno por estrés postraumático (TEPT). Los objetivos de este estudio fueron estimar la magnitud y dirección de la asociación entre neuroticismo y TEPT así como analizar la influencia de diferentes variables moderadoras sobre el tamaño del efecto. Métodos: Se realizó una revisión sistemática y un metaanálisis. La búsqueda de estudios se efectuó en Medline, IME, PsycINFO, Trip Databse y Google Scholar, siendo el límite temporal hasta octubre de 2012. También se hizo una búsqueda manual y se contactó con los autores principales. Criterios de inclusión: (a) estudios empíricos que analizaran la asociación entre neuroticismo y TEPT mediante escalas validadas o criterios diagnósticos (DSM, CIE); (b) en sujetos expuestos a un evento traumático y (c) escritos en inglés o español. Dos evaluadores independientes realizaron la selección y codificaron los datos siguiendo el protocolo previamente elaborado. Se aplicó el modelo de efectos aleatorios para obtener el tamaño del efecto medio y explorar variables moderadoras. Resultados: De 96 artículos elegibles, 34 cumplieron los criterios de inclusión (9.941 participantes). El tamaño del efecto medio fue r+=0,371 (IC95%: 0,3270,414). Se descartó que hubiera sesgo de publicación. Se construyó un modelo predictivo con tres variables (reporte de la etnia, edad y tipo de muestra: comunitaria o clínica). Conclusión: El neuroticismo puede considerarse un factor de riesgo para el TEPT en personas que han estado expuestas a un evento traumático. Estos hallazgos son importantes para la elaboración de actuaciones preventivas y de intervención (AU)

Background: There are conflicting results on the role of neuroticism as a risk factor for posttraumatic stress disorder (PTSD). The objectives of this study were to estimate the magnitude and direction of the association between neuroticism and PTSD, and to analyze the influence of different moderator variables on effect size. Methods: A systematic review and a metaanalysis were carried out. The search for studies was conducted in Medline, IME, PsycINFO, Trip Database, and Google Scholar, until October 2012.Ahand search was also carried out and main researchers were contacted. Inclusion criteria: (a) empirical studies of the association between neuroticism and PTSD using validated scales or diagnostic criteria (DSM, ICD), (b) in participants exposed to a traumatic event and (c) written in English or Spanish. Two independent evaluators performed the selection and extracted the data following a previously developed protocol. The randomeffects model was applied to obtain the mean effect size and to explore moderators. Results: Out of 96 potential articles, 34 fulfilled the inclusion criteria (9,941 participants). The mean effect size was r+ = 0.371 (95%CI: 0.327 and 0.414). Publication bias was discarded as a threat.Apredictive model was elaborated with three variables (reporting of ethnicity, age, and type of sample). Conclusion: Neuroticism can be considered as a risk factor for PTSD in people who have been exposed to a traumatic event. These findings are relevant for developing preventive interventions and treatments (AU)

Reliability and failure modes of implant-supported Y-TZP and MCR three-unit bridges.

PURPOSE: Chipping within veneering porcelain has resulted in high clinical failure rates for implant-supported zirconia (yttria-tetragonal zirconia polycrystals [Y-TZP]) bridges. This study evaluated the reliability and failure modes of mouth-motion step-stress fatigued implant-supported Y-TZP versus palladium-silver alloy (PdAg) three-unit bridges. MATERIALS AND METHODS: Implant-abutment replicas were embedded in polymethylmethacrylate resin. Y-TZP and PdAg frameworks, of similar design (n = 21 each), were fabricated, veneered, cemented (n = 3 each), and Hertzian contact-tested to obtain ultimate failure load. In each framework group, 18 specimens were distributed across three step-stress profiles and mouth-motion cyclically loaded according to the profile on the lingual slope of the buccal cusp of the pontic. RESULTS: PdAg failures included competing flexural cracking at abutment and/or connector area and chipping, whereas Y-TZP presented predominantly cohesive failure within veneering porcelain. Including all failure modes, the reliability (two-sided at 90% confidence intervals) for a "mission" of 50,000 and 100,000 cycles at 300 N load was determined (Alta Pro, Reliasoft, Tucson, AZ, USA). No difference in reliability was observed between groups for a mission of 50,000. Reliability remained unchanged for a mission of 100,000 for PdAg, but significantly decreased for Y-TZP. CONCLUSIONS: Higher reliability was found for PdAg for a mission of 100,000 cycles at 300 N. Failure modes differed between materials.

Próteses fixas implanto-suportadas de 3 elementos: zircônia versus metalocerâmica / Three-unit implant-supported fixed parcial dentures: zirconia versus metal-ceramic

A falha coesiva na porcelana de revestimento de próteses com infraestruturas de policristais de zircônia tetragonal estabilizada por ítrio (PZT-I) tem causado elevadas taxas clínicas de fracassos. No presente estudo avaliou-se a confiabilidade e modos de fratura de próteses fixas implanto-suportadas confeccionadas em uma liga de paládio-prata (PdAg) e em PZT-I, submetidas à fadiga acelerada progressiva. Embebeu-se análogos de implantes em uma resina acrílica. Infraestruturas em PZT-I e PdAg (n = 21/grupo) foram fabricadas, revestidas com porcelana, cimentadas e submetidas a uma carga estática (n = 3/grupo) para obtenção dos valores de resistência à fratura. Em seguida, 18 espécimes de cada grupo foram distribuídos ao longo de 3 perfis de estresse progressivo e submetidos à fadiga em água com a carga aplicada na cúspide vestibular do pôntico. Encontrou-se no grupo PdAg um modo de fratura incluindo trincas flexurais na área do conector competindo com a falha coesiva da porcelana, enquanto que as próteses em PZT-I apresentaram falha coesiva na porcelana de revestimento. O cálculo da confiabilidade (Alta Pro, Relia Soft, intervalo de confiança de 90%, bilateral) revelou confiabilidade significativamente inferior para o grupo PZT-I na finalização de uma missão de 100.000 ciclos a 300 N quando comparada ao grupo PdAg. Concluiu-se que para uma missão de 100.000 ciclos a 300 N a confiabilidade é mais alta para a prótese metalocerâmica quando comparada à em PZT-I. Os modos de fratura diferiram entre os grupos.

Statement of problem: chipping within veneering porcelain has resulted in high clinical failure rates for implant-supported zirconia (Y-TZP) bridges. This study evaluated the reliability and failure modes of mouth-motion step-stress fatigued implant-supported Y-TZP versus Palladium-Silver alloy (PdAg) three-unit bridges. Methods: Implant-abutment replicas wereembedded in polymethylmethacrylate resin. Y-TZP and PdAg frameworks, of similar design (n = 21 each), were fabricated, veneered, cemented (n = 3 each), and Hertzian contact tested to obtain ultimate failure load. In each framework group eighteen specimens were distributed across 3 stepstress profiles and mouth-motion cyclically loaded according to the profile on the lingual slope of the buccal cusp of the pontic. Results: PdAg failures included competing flexural cracking at abutment and/or connector area and chipping, whereas Y-TZP presented predominantly cohesive failure within veneering porcelain. Including all failure modes, the reliability (2-sided at 90% confidence intervals) for a “mission” of 100,000 cycles at 300 N load was determined (Alta Pro, Reliasoft). Reliability remained unchanged for a mission of 100,000 for PdAg, but significantly decreased for Y-TZP. Conclusion: Higher reliability was found for PdAg for a mission of 100,000 cycles at 300N. Failure modes differed between materials.

Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome.

BACKGROUND: This study was designed to assess the safety and effectiveness of stapled transanal rectal resection (STARR) and to compare the results of two staplers. STUDY DESIGN: From February 2001 to June 2005, 37 patients diagnosed with obstructive defecation syndrome were treated with the STARR technique. We analyzed variables related to the patient, diagnosis based on anorectal exploration, surgical technique used, and clinical and radiologic results. We compared these results in patients with procedure prolapsed hemorrhoids (PPH)33-01 (group 1, n = 17) or PPH33-03 (group 2, n = 20). The patients were followed postoperatively at 1, 3, and 6 months, and annually. RESULTS: Intraoperative hemorrhage at the stapled suture occurred in 13 patients from group 1 and in 6 patients from group 2 (p = 0.03). The degree of postoperative pain was not different between the two groups. During the followup period, radiologic and clinical correction of the rectocele and intussusception was found in 94.6% of the patients, with a recurrence in 1 patient from each group. One patient from group 1 developed stenosis of the anastomosis, which improved with digital dilatations. Six patients from group 1 and none from group 2 (p < 0.05) had granulomas on the staple line at the sites of the reabsorbable reinforcing stitches, which were related to postoperative bleeding and anal discomfort. CONCLUSIONS: STARR is an effective alternative for treatment of obstructive defecation syndrome, with a low morbidity and a shorter hospital stay. The use of PPH33-03 instead of PPH33-01 decreases the risk of hemorrhagic complications and enables more secure implantation as an outpatient procedure.

Tratamiento laparoscópico del quiste esplénico primario / Laparoscopic treatment of primary splenic cyst

No disponible