Diseño y validación de un cuestionario para la detección de Abusos Sexuales Infantiles en personas adultas con adicción / Design and validation of a questionnaire for the detection of child sexual abuse in adults with addiction

Introducción y objetivos: el objetivo principal de este trabajo ha sido diseñar y validar un cuestionario específico que evaluara el Abuso Sexual Infantil (ASI) en personas adultas con problemas de adicción. Materiales y método: se diseñó un cuestionario de 120 ítems que medía diferentes secuelas psicopatológicas que están presentes en personas que han sufrido ASI. Se realizó su validación con un grupo de expertos y un estudio piloto en el que participaron 151 personas (68 mujeres y 83 hombres), residentes en España. Para el análisis de datos se usaron diferentes métodos estadísticos. Resultados: los resultados mostraron que el cuestionario se podía reducir a 21 ítems logrando alcanzar unas adecuadas garantías psicométricas, tanto a nivel de validez como de fiabilidad (a = ,872). Conclusiones: El presente instrumento permite la detección de sintomatología relacionada con el ASI, permitiendo al clínico hacer una exploración más amplia en esta área para descartar ASI u otros trastornos y poder mejorar la planificación del tratamiento.(AU)

Introduction and objectives: the main objective of this work has been to design and validate a specific questionnaire to assess Child Sexual Abuse (CSA) in adults with addiction problems. Materials and method: a 120-item questionnaire was designed to measure different psychopathological sequelae that are present in people who have suffered CSA. Validation was carried out with a group of experts and a pilot study in which 151 people (68 women and 83 men) residing in Spain participated. Different statistical methods were used for data analysis. Results: the results showed that the questionnaire could be reduced to 21 items, achieving adequate psychometric guarantees, both in terms of validity and reliability (a = ,872). Conclusions: The present instrument allows the detection of symptoms related to ASI, allowing the clinician to carry out a broader exploration in this area to rule out ASI or other disorders and to improve treatment planning.(AU)

Hiperparatiroidismo primario asociado a neoplasia endocrina múltiple tipo 1 (MEN 1). Experiencia en 71 casos / Primary hyperparathyroidism associated with MEN 1: Experience in 71 cases

INTRODUCCIÓN: El hiperparatiroidismo (HPT) asociado al MEN 1 se caracteriza por ser una afectación multiglandular, no afectándose todas las glándulas en el mismo momento. Suele ser asintomático, aunque la afectación ósea es elevada en los pacientes jóvenes. Las tasa de recidiva y persistencias es de 25-35%. Los objetivos fueron: a) estudiar HPT-MEN 1; y b) analizar las variables relacionadas con la presencia o no de clínica y con la persitencia. MÉTODO: De 97 sujetos con MEN 1 diagnosticados en el HUVA, Murcia, pertenecientes a 16 familias, se han estudiado restrospectivamente 71 pacientes con afectación paratiroidea. Las variables estudiadas son: mutación, edad de diagnóstico, clínica, los valores de calcio, fóforo y PTHi, MIBI, técnica quirúrgica, valores de la PTHi y tasa de recidiva. RESULTADOS: La edad media fue de 38 años, y 50 estaban asintomáticos en el momento del diagnóstico. La técnica quirúgica realizada fue: paratiroidectomía subtotal (n = 55), paratiroidectomía de 3 glándulas (n = 7) y resección de menos de 3 glándulas (n = 9). Se asoció timectomía transcervical en 53. El seguimiento medio ha sido de 102,9 meses. Se han encontrado 21 recidivas (10 cirugía incompleta). Encontramos una relación estadísticamente significativa entre: la edad de diagnóstico (p < 0,0005) y los valores elevados de calcio (p < 0,008) y la presencia de clínica en el momento del diagnóstico, la técnica quirúrgica incompleta (p < 0,003), no timectomía (p < 0,0001) y seguimiento (p < 0,001) y la recidiva tras la cirugía. CONCLUSIÓN: La realización de screening genético y clínico nos permite un diagnóstico en fase asintomática y tratamiento precoz, evitando así complicaciones secundarias a la evolución del HPT. La tasa de recidiva del HPT en el MEN 1 es elevada, siendo los factores de recidiva el tiempo de seguimiento y la técnica quirúrgica realizada

INTRODUCTION: Primary hyperparathyroidism (pHPT) in MEN 1 is characterized by multiglandular disease and early involvement of parathyroid glands at different times. Persistence and recurrence range from 25%-35%. The purpose was: a) to describe the experience and the treatment of patients with pHPT in MEN 1; b) to analyze the variables related with clinical presentation and recurrence. METHOD: A total of 97 patients with MEN 1 were diagnosed in a tertiary hospital. A retrospective analysis was made in patients with pHPT (n = 71). Study variables: age at diagnosis, mutation, clinical presentation, laboratory tests, surgical technique, and recurrence of HPT. RESULTS: Mean age was 38 years, and 50 patients were asymptomatic. The surgical technique was: subtotal parathyroidectomy (n = 55), resection of three glands (n = 7), and resection of less glands (n = 9). Transcervical thymectomy was performed in 53 patients. Mean follow-up was 102.9 months. There were 21 recurrences, There were correlations between age at diagnosis and serum calcium levels with the presence of symptoms (P < .0001). There were also correlations between recurrence and surgical technique (P < .03), non-association with thymectomy (P < .0001), and follow-up time (P < .03). CONCLUSION: Performing genetic and clinical screening allows us to make a diagnosis in the asymptomatic period and to provide early treatment for HPT in MEN 1. The recurrence rate is high, and follow-up time and the surgical technique used are risk factors for recurrence

Cooperación en cirugía en el siglo XXI / Cooperation in surgery of the 21st century

La necesidad de cooperación sanitaria en países de bajo desarrollo es conocida y se implementa día a día. Sin embargo, la asistencia sanitaria quirúrgica en estos países, en el siglo XXI, es más discutida, y se encuentra por debajo de niveles deseables y con soluciones más complejas. Por otra parte, el número de cirujanos que buscan implicarse aumenta progresivamente. Se analizan las causas que originan estos bajos niveles de asistencia, como la falta de personal cualificado, fuga de profesionales, coste de la asistencia o la falta de cuantificación de las necesidades. Las oportunidades de mejora, como el hermanamiento institucional, las misiones quirúrgicas de corta duración o la realización de acciones dirigidas a la educación, evaluación, evidencia y formación son algunas de las posibilidades propuestas

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed

Cooperation in surgery of the 21st century. / Cooperación en cirugía en el siglo XXI.

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed.

Primary hyperparathyroidism associated with MEN 1: Experience in 71 cases. / Hiperparatiroidismo primario asociado a neoplasia endocrina múltiple tipo 1 (MEN 1). Experiencia en 71 casos.

INTRODUCTION: Primary hyperparathyroidism (pHPT) in MEN 1 is characterized by multiglandular disease and early involvement of parathyroid glands at different times. Persistence and recurrence range from 25%-35%. The purpose was: a) to describe the experience and the treatment of patients with pHPT in MEN 1; b) to analyze the variables related with clinical presentation and recurrence. METHOD: A total of 97 patients with MEN 1 were diagnosed in a tertiary hospital. A retrospective analysis was made in patients with pHPT (n=71). STUDY VARIABLES: age at diagnosis, mutation, clinical presentation, laboratory tests, surgical technique, and recurrence of HPT. RESULTS: Mean age was 38 years, and 50 patients were asymptomatic. The surgical technique was: subtotal parathyroidectomy (n=55), resection of three glands (n=7), and resection of less glands (n=9). Transcervical thymectomy was performed in 53 patients. Mean follow-up was 102.9 months. There were 21 recurrences, There were correlations between age at diagnosis and serum calcium levels with the presence of symptoms (P<.0001). There were also correlations between recurrence and surgical technique (P<.03), non-association with thymectomy (P<.0001), and follow-up time (P<.03). CONCLUSION: Performing genetic and clinical screening allows us to make a diagnosis in the asymptomatic period and to provide early treatment for HPT in MEN 1. The recurrence rate is high, and follow-up time and the surgical technique used are risk factors for recurrence.

Infección letal por Streptococcus del grupo A en cirugía tiroidea: la importancia de un diagnóstico precoz / Lethal infection by Streptococcus group A in thyroid surgery: the importance of an early diagnosis

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Factores pronósticos de los tumores neuroendocrinos de páncreas resecados. Experiencia en 95 pacientes / Prognostic factors in resected pancreatic neuroendocrine tumours: Experience in 95 patients

INTRODUCCIÓN: El objetivo de este estudio fue analizar los factores pronósticos que influyen en la supervivencia y en la recidiva en una serie de pacientes diagnosticados de tumores neuroendocrinos de páncreas (TNEP) y tratados mediante resección quirúrgica. MÉTODOS: Serie retrospectiva de 95 pacientes intervenidos y resecados de TNEP. Las variables estudiadas son: edad, sexo, forma de presentación (esporádica/familiar), funcionalidad, tipo de tumor, localización, cirugía realizada, tamaño tumoral, multifocalidad, tasa de curación y de recidiva. Se ha utilizado la nueva clasificación de la OMS en 2010. RESULTADOS: De los 95 pacientes, 45 eran varones y 50 mujeres, con una edad media de 47,6 años. Presentación esporádica en 66 pacientes (69,8%) y familiar en los 29 restantes (30,2%), asociados a síndrome MEN 1. El 59% (56 pacientes) eran no funcionantes y el 41% restante funcionantes. Los TNEP funcionantes incluían 20 insulinomas, 16 gastrinomas y 3 glucagonomas. La técnica quirúrgica más utilizada (42 pacientes) fue la pancreatectomía corporocaudal. Según la clasificación de la OMS (2010), 59 pacientes presentaban un TNEP G1, 24 un TNEP G2 y los 12 pacientes restantes un carcinoma pobremente diferenciado. La supervivencia a los 5 años en los tumores bien diferenciados ha sido del 100%, independientemente de la funcionalidad. Los TNE esporádicos suelen ser unifocales (p < 0,001) y se asocian a metástasis hepáticas. El seguimiento medio ha sido de 85,3 meses, con una tasa de supervivencia del 65,8% y de recidiva del 24%. CONCLUSIONES: En nuestra experiencia, la clasificación de la OMS (2010) es un factor pronóstico independiente en la supervivencia de los TNEP

INTRODUCTION: The aim of this study was to analyze prognostic factors for survival and recurrence in patients with resected pancreatic neuroendocrine tumors (PNT). METHODS: Medical records of 95 patients with resected PNT were retrospectively reviewed. The variables studied were: age, sex, form of presentation (sporadic/familial tumors), functionality, type of tumor, localization, type of surgery, tumor size, multifocal tumors and recurrent rate. The new WHO classification (2010) was used. RESULTS: There were 45 men and 50 women. Mean age was 46.8 years. Regarding the mode of presentation, it was sporadic in 66 patients (69.8%) and 29 cases were familial neuroendocrine tumors (30.2%) in association with MEN 1 syndrome. The 59% of patients suffered from non-functional tumors and 41% were functional: 20 insulinoma, 16 gastrinoma, and 3 glucagonoma. Distal pancreatectomy was the most common surgical procedure, followed by tumor enucleation in 19 patients. According to the WHO classification, 59 patients had a PNT G1, 24 PNT G2 and 12 with a poorly-differentiated carcinoma, respectively. The 5-year survival in well-differentiated tumors was 100%, regardless of the functionality. Sporadic PNT are more commonly unifocal (P<0.001), associating liver metastasis. Survival and recurrence rates after a mean follow-up of 85.3 months were 65.8 and 24%, respectively. CONCLUSIONS: In our experience, WHO classification was an independent prognostic factor in PNT survival

Prognostic factors in resected pancreatic neuroendocrine tumours: Experience in 95 patients. / Factores pronósticos de los tumores neuroendocrinos de páncreas resecados. Experiencia en 95 pacientes.

INTRODUCTION: The aim of this study was to analyze prognostic factors for survival and recurrence in patients with resected pancreatic neuroendocrine tumors (PNT). METHODS: Medical records of 95 patients with resected PNT were retrospectively reviewed. The variables studied were: age, sex, form of presentation (sporadic/familial tumors), functionality, type of tumor, localization, type of surgery, tumor size, multifocal tumors and recurrent rate. The new WHO classification (2010) was used. RESULTS: There were 45 men and 50 women. Mean age was 46.8 years. Regarding the mode of presentation, it was sporadic in 66 patients (69.8%) and 29 cases were familial neuroendocrine tumors (30.2%) in association with MEN 1 syndrome. The 59% of patients suffered from non-functional tumors and 41% were functional: 20 insulinoma, 16 gastrinoma, and 3 glucagonoma. Distal pancreatectomy was the most common surgical procedure, followed by tumor enucleation in 19 patients. According to the WHO classification, 59 patients had a PNT G1, 24 PNT G2 and 12 with a poorly-differentiated carcinoma, respectively. The 5-year survival in well-differentiated tumors was 100%, regardless of the functionality. Sporadic PNT are more commonly unifocal (P<0.001), associating liver metastasis. Survival and recurrence rates after a mean follow-up of 85.3 months were 65.8 and 24%, respectively. CONCLUSIONS: In our experience, WHO classification was an independent prognostic factor in PNT survival.

Hiperparatiroidismo asociado al litio / Lithium-associated hyperparathyroidism

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Fibrosarcoma del adulto: manejo quirúrgico en países en vías de desarrollo / Adult fibrosarcoma: Surgical management in developing countries

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[Adrenal surgery in Spain: final results of a national survey]. / Cirugía suprarrenal en España: resultados finales de una encuesta nacional.

INTRODUCTION: The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments. MATERIAL AND METHODS: Data was gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann-Whitney Test for the quantitative variables and chi squared for the qualitative ones. RESULTS: Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%). Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach (P=.019), and had a shorter overall hospital stay (P<.0001). Laparoscopic adrenalectomy was also associated with a shorter hospital stay (P<.0001). CONCLUSIONS: Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay.

Hemorragia digestiva baja grave de origen diverticular / Severe lower gastrointestinal tract bleeding due to diverticulosis

Introducción. La diverticulosis supone la causa más frecuente de hemorragia digestiva baja (HDB) en pacientes adultos de países occidentales. Los objetivos son analizar: 1) el manejo diagnóstico-terapéutico de los pacientes con HDB severa de origen diverticular; 2) valorar la morbimortalidad asociada; 3) analizar la necesidad de cirugía, y 4) valorar los índices de recidiva de la hemorragia tras el alta hospitalaria. Material y métodos. Se revisan retrospectivamente 42 pacientes con HDB grave de origen diverticular. Fueron considerados los siguientes casos: pacientes con rectorragias que requirieron la transfusión de al menos tres concentrados de hematíes y aquéllos pacientes que presentaron un descenso del hematocrito igual o mayor a 10 puntos. Como grupo control se utilizaron 133 HDB graves en pacientes donde las etiologías no eran la enfermedad diverticular colónica. Resultados. Todos los pacientes se estabilizaron con medidas conservadoras excepto uno que precisó cirugía urgente. Se realizó colonoscopia a 39 pacientes siendo lo más frecuente hallar signos recientes de hemorragia con independencia del momento de su realización precoz o tardía. En un caso se realizó tratamiento endoscópico mediante electrocoagulación con láser de Argón. El índice de recidiva de hemorragia tras el alta hospitalaria fue del 31% de los pacientes (n=13), precisando 7 de ellos (16%) reingreso hospitalario. Conclusión. La HDB grave de origen diverticular cede en la mayoría de los casos con tratamiento conservador aunque con un alto porcentaje de recidiva de la hemorragia. La realización de endoscopia precoz no es tan importante como en el resto de causas de HDB grave (AU)

Introduction. Diverticulosis is the most frequent cause of lower gastrointestinal (GI) bleeding in adults in western countries. The aims of the present study were to analyze: 1) the diagnostic and therapeutic management of patients with severe lower GI bleeding due to diverticulosis; 2) associated morbidity and mortality; 3) the need for surgery, and 4) bleeding recurrence rates after hospital discharge. Material and methods. Were retrospectively reviewed 42 patients with severe lower GI bleeding due to diverticulosis. Patients with rectorrhagia requiring transfusion of at least three packed red blood cell units and those with a decrease in hematocrit of 10 points or more were included. As a control group, we used 133 patients with severe lower GI hemorrhage due to causes other than colonic diverticular disease. Results. All patients were stabilized with conservative measures except one who required emergency surgery. Colonoscopy was performed in 39 patients and the most frequent finding consisted of recent signs of bleeding independently of whether colonoscopy was performed early or was delayed. Endoscopic treatment with Argon laser electrocoagulation was performed in one patient. Bleeding recurrence after hospital discharge occurred in 13 patients (31%); of these, seven (16%) required hospital readmission. Conclusion. Severe lower GI bleeding due to diverticulosis can usually be resolved with conservative treatment although the percentage of bleeding recurrence is high. Early endoscopy is not as important as in the remaining causes of severe lower GI bleeding (AU)