Asociación de la rigidez aórtica con calcificaciones vasculares abdominales y coronarias en pacientes con enfermedad renal crónica estadios 3 y 4 / Association of aortic stiffness with abdominal vascular and coronary calcifications in patients with stage 3 and 4 chronic kidney disease

Fundamento y objetivos: El aumento de la rigidez arterial central (aórtica) tiene repercusiones hemodinámicas con efectos nocivos cardiovasculares y renales. En la enfermedad renal crónica (ERC) puede existir un aumento de la rigidez aórtica secundaria a múltiples alteraciones metabólicas, entre ellas la calcificación de la pared vascular (CV). El objetivo de este estudio fue analizar la asociación de la rigidez aórtica y de la hemodinámica central con la presencia de CV en dos territorios: aorta abdominal (CAA) y arterias coronarias (CC). Material y métodos: Se incluyeron 87 pacientes con ERC estadios 3 y 4. Usando tonometría de aplanamiento se estudiaron la hemodinámica central y la rigidez aórtica. Esta se determinó mediante la velocidad de pulso carótida-femoral (Vpc-f). A partir de la Vpc-f se calculó el índice de la VPc-f (iVpc-f) que considera otras variables que influyen en la Vpc-f, como edad, presión arterial, sexo y frecuencia cardiaca. La presencia de CAA se valoró mediante radiografía lateral de columna lumbar calculándose el índice de Kauppila (iKauppila) y las CC mediante tomografía computarizada multidetección por el método de Agatston, calculándose su índice (iAgatston). Para el estudio de la asociación entre iVpc-f, iKauppila, iAgatston, presión aórtica central, parámetros clínicos y datos de laboratorio se usaron la regresión múltiple y la regresión logística. La capacidad discriminativa del iVpc-f para evaluar la presencia de CAA y CC se determinó mediante el área bajo la curva (ABC) de ROC (receiver-operating characteristic). Resultados: La Vpc-f y el iVpc-f fueron 11,3±2,6m/s y 10,6m/s, respectivamente. El iVpc-f fue mayor cuando la ERC coexistía con diabetes mellitus (DM). Se detectaron CAA y CC en el 77% y el 87%, respectivamente. La albuminuria (β=0,13, p=0,005) y el iKauppila (β=0,36, p=0,001) se asociaron de forma independiente con la magnitud del iVpc-f... (AU)

Rationale and objectives: Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC). The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries (CAC). Materials and methods: We included 87 patients with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respectively. For the study of the association between iPvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). Results: Pvc-f and Pvc-f index were 11.3±2.6m/s and 10.6m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively. Albuminuria (β=0.13, p=0.005) and Kauppila score (β=0.36, p=0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β=0.39, p=0.001), DM (β=0.46, p=0.01), and smoking (β=0.53; p=0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6–6.9; p=0.001)]. The Kauppila score was independently associated with the Agatston score (β=1.53, p=0.001)... (AU)

Single incision approach for splenic diseases: a preliminary report on a series of 8 cases.

BACKGROUND: There is a current trend to reduce the invasiveness of minimally invasive procedures, and the single-incision laparoscopic approach (SILS) has been proposed for several intra-abdominal surgical interventions. The spleen poses specific problems for techniques, such as SILS, due to its volume and texture, and little clinical information is available on the topic. We describe our initial experience using SILS for the management of splenic diseases. METHODS: Between December 2008 and September 2009, we attempted SILS in eight patients: four men and four women with a median age of 44 (range, 26-73) years, and body mass index of 24.5 (range, 18-31). Preoperative diagnosis was malignancy (n = 3), ITP (n = 1), HIV-related hypersplenism (n = 1), spherocytosis (n = 1), and splenic cyst (n = 2). SILS was attempted transumbilically in four cases and through a 15-mm subcostal single incision in the other four. As entry port we used either three trocars (one of 12 mm and two of 5 mm) inserted through the single-site incision or the umbilicus, or a multiport (Triport, Olympus) device. Instrumentation used consisted of curved instruments, a flexible-tip 10-mm scope, and the harmonic scalpel. Visualization of the spleen and standard dissection of attachments was accomplished, and splenectomy was completed by stapling of the splenic hilum. The spleen was extracted through the single-site incision. In two cases, unroofing of a splenic cyst was performed transumbilically. RESULTS: The SILS procedure was successful in six of the eight patients (75%). Conversion to conventional laparoscopic splenectomy (LS) was required in two patients due to adhesions and spleen size. Median operative time was 97 (range, 60-150) min. There were no postoperative complications, and median stay was 4 (range, 2-5) days. Median spleen weight was 485 (range, 340-590) g. CONCLUSIONS: SILS access can be safely used for operative visualization, hilum transection, and spleen removal, further reducing parietal wall trauma. The definitive clinical, esthetic, and functional advantages require further analysis.

[Laparoscopic treatment of rectal prolapse]. / Tratamiento laparoscópico del prolapso rectal.

INTRODUCTION: Rectal prolapse is an uncommon disease mainly seen in patients of advanced age. It is treated surgically, although there is still significant controversy as regards the most appropriate technique. In the last few years the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. OBJECTIVE: To present the preliminary results of a series of patients with rectal prolapse, the majority of whom were treated by performing a laparoscopic posterior rectopexy. MATERIAL AND METHOD: Between February 1998 and February 2008, 17 patients diagnosed with total rectal prolapse were operated on. In 15 cases, a Wells type posterior rectopexy was performed and in the other two a sigmoidectomy was done. The pre-surgical characteristics, as well as the immediate post-surgical results and the long-term follow up results were analysed. RESULTS: The mean age of the series was 63 (21-87) years, with a mean operation time of 186 (105-240) min and a conversion index of 6.6%. There was no post-surgical morbidity and mortality and the mean hospital stay was 5.2 (3-8) days. The mean follow-up was 39 (6-96) months with no relapses seen. One patient had an intralumen migration of the mesh which was expulsed via the rectum, two years after the surgery. One patient died during follow-up due to his underlying severe cardio-respiratory disease. The prolapse re-occurred in one patient after a sigmoidectomy. Eight patients (53%) previously had constipation and in six cases (40%), incontinence. In the post-surgical reviews, constipation persisted in three patients (20%) and a it was seen de novo in one case (6.6%). The incontinence was resolved in four cases (26%) and persisting in two patients (13%). CONCLUSIONS: Laparoscopic rectopexy is a good technical option with a low morbidity-mortality and a reduced hospital stay, as well as good results in the long-term.

Tratamiento laparoscópico del prolapso rectal / Laparoscopic treatment of rectal prolapse

Introducción. El prolapso rectal es una enfermedad infrecuente que predomina en edades extremas de la vida. Su tratamiento es quirúrgico, aunque continúa habiendo una importante controversia en cuanto a la técnica más adecuada. En los últimos años la aplicación de la vía laparoscópica se ha demostrado factible y se acompaña de las ventajas de una técnica mínimamente invasiva. Objetivo. Presentar los resultados preliminares de una serie de pacientes afectos de prolapso rectal que fueron abordados por laparoscopia; en la mayoría de ellos se practicó una rectopexia posterior laparoscópica. Material y método. Entre febrero de 1998 y febrero de2008, se ha intervenido a 17 pacientes diagnosticados de prolapso rectal total. En 15 casos se realizó una rectopexia posterior tipo Wells por laparoscopia y en los otros dos, una sigmoidectomía. Se analizaron las características preoperatorias y los resultados en el postoperatorio inmediato y el seguimiento a largo plazo. Resultados. La media de edad de la serie es 63 (21-87) años y la del tiempo operatorio, 186 (105-240) min; el índice de conversión fue del 6,6%. La morbimortalidad postoperatoria fue nula, con una media de estancia hospitalaria de 5,2 (3-8) días. La media del seguimiento fue de 39 (6-96) meses, y no se han objetivado recidivas. En 1 paciente se produjo la (..) (AU)

Introduction. Rectal prolapsed is an uncommon disease mainly seen in patients of advanced age. It is treated surgically, although there is still significant controversy as regards the most appropriate technique. In the last few years the laparoscopic route has-been shown to be feasible and has the advantage of being a minimally invasive technique. Objective. To present the preliminary results of a series of patients with rectal prolapse, the majority of whom were treated by performing a laparoscopic posterior rectopexy. Material and method. Between February 1998 and February2008, 17 patients diagnosed with total rectal prolapsed were operated on. In 15 cases, a Wells type (..) (AU)