Expanding indication of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to suprapubic area: LIRA & TAPE.

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique described to repair M2-M4 primary and incisional hernias. Defects below this area (M5 - Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps in the combination of LIRA & TAPE for M2-M5 ventral hernias.

Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion.

PURPOSE: To compare the evolution of the cardiometabolic parameters in patients with nonfunctioning adrenal incidentalomas (NFAI) and autonomous cortisol secretion (ACS) who underwent adrenalectomy and those who were conservatively managed. METHODS: A retrospective study of all patients with NFAI and ACS submitted to surgery or in follow-up in our center between January 2011-October 2020. NFAI was defined as an adrenal incidentaloma with cortisol post-dexamethasone suppression test (DST) ≤ 50 nmol/L and ACS as values >50 nmol/L without specific clinical signs of overt Cushing´s syndrome. RESULTS: A total of 486 patients with NFAI (16 in the surgical group and 470 in the control group) and 259 with ACS (42 in the surgical group and 217 in the control group) were included. At baseline, patients with ACS were older than those with NFAI (P = 0.010). After adjusting by age, patients with ACS had a higher prevalence of hypertension (adjusted OR = 1.9 [1.36-2.60]) and higher levels of fasting plasma glucose and HbA1c (adjusted ß = 6.9 [2.05-11.83] and adjusted ß = 0.4 [0.12-0.63]) than NFAI. During follow-up, ACS patients who underwent adrenalectomy had a greater decrease in glucose levels (-16.6 ± 45.07 vs. -1.0 ± 26.92 mg/dL, P = 0.035) and in triglycerides (-20.21 ± 55.97 vs. 1.3 ± 59.23 mg/dL, P = 0.029) than ACS patients conservatively managed. NFAI patients who underwent surgery experienced an improvement in systolic blood pressure compared to NFAI of the conservative group (-11.1 ± 15.94 vs 1.0 ± 17.54 mmHg, P = 0.009). CONCLUSION: The benefits of adrenalectomy in the cardiometabolic profile in adrenal incidentalomas are not limited only to the group of patients with ACS, an improvement in blood pressure control is also observed in NFAI patients after surgery.

Minimally invasive repair of ventral hernia with one third of tackers and fibrin glue: less pain and same recurrence rate.

BACKGROUND: Aim of this study was to assess whether the reduction in the number of tackers maintains a similar recurrence rate and to subsequently evaluate whether this reduction associated with fibrin adhesive (FA) influences postsurgical pain after laparoscopic ventral hernia repair (LVHR) at 5 years follow-up. METHODS: Fifty patients with ventral hernia (intervention group) underwent to LVHR with the double crown (DC) technique with a decrease in the number of tackers, each tacker being separated by about 3 cm associated with FA to seal the spaces between them. Data obtained from intervention group were compared to data obtained from a historical series of 50 patients (control group) undergoing LVHR using DC technique with tackers at 1 cm each other. RESULTS: No statistically significant differences were found between groups about patients' characteristics. Mean hospital stay was 2 days. Statistically significant differences were observed about hospital stay between both groups U-Mann-Whitney ([UMW] =345, P=0) being higher in the control group. Statistically significant difference was observed in the postoperative pain evaluated by the visual analogical scale (VAS) score, having 95% of patients in the control group with VAS less than or equal to 7 compared to 4.55 in the intervention group. Recurrence rate was 4.1% for the control group versus 4.2% in the intervention group. CONCLUSIONS: The reduction of metallic tackers associated with FA does not present statistically significant differences in the recurrence rate in comparison to conventional DC technique. In the intervention group a reduction in postoperative pain and hospital stay were observed.

Evaluación de estructuras cerebrales por resonancia magnética en personas infectadas con el virus de la inmunodeficiencia humana (VIH) y adherentes al tratamiento antirretroviral / Evaluation by MRI of brain structures of HIV subjects with adherence to antiretroviral therapy

Introducción: los cambios estructurales del cerebro se pueden observar en fases tempranas de la infección por VIH y acelerarse en estadios avanzados, aunque queda por profundizar con más estudios clínicos la relación que pueda existir entre la adherencia al tratamiento antirretroviral y los cambios en los volúmenes de las estructuras cerebrales. Objetivo: identificar los cambios en estructurascerebrales de personas infectadas con VIH por medio de la resonancia magnética y explorar su relación con el tratamiento antirretroviral. Materiales y métodos: se eligieron 2 grupos, cada uno con 16 individuos; el primero conformado por personas infectadas con VIH y tratamiento adherente y el segundo con individuos no infectados (grupo control). Los volúmenes de las estructuras corticales, subcorticales, las regiones superficiales de la sustancia blanca y gris fueron calculados para los dos hemisferios, en los cuales se utilizaron algoritmos automáticos de la plataforma de análisis de imágenesFreeSurfer. Los datos anatómicos de los individuos fueron adquiridos en un equipo de resonancia magnética 3T en el Instituto de Alta Tecnología Médica (IATM), Medellín, Colombia. Resultados: el análisis de las estructuras corticales y subcorticales no arrojó diferencias significativas entre las volumetríasdel grupo control y los individuos infectados con VIH/adherentes al tratamiento. Conclusión: los hallazgos muestran que el cerebro puede estar posiblemente sin alteraciones en sus estructuras corticales y subcorticales en los individuos con VIH adherentes al tratamiento, en primera o segunda línea de tratamiento antirretroviral, y, a la vez, estos resultados pueden aportar nuevas estrategias de neuroprotección ante el autocuidado frente al esquema de tratamento.

Introduction: structural brain changes can be detected in early stages of HIV infection and may be accelerated in advanced stages, however it still important to have more clinic studies for analyze the relationship between the adherence to antiretroviral therapy and changes in the volume of brain structures. Objective: To identify changes in brain structures from HIV subjects by using Magnetic Resonance Imaging (MRI) and to correlate the findings with the antiretroviral treatment. Materials and methods: Two groups with 16 subjects were chosen: a HIV group of subjects with medication adherence and healthy subjects (control group). By using the automatic segmentation software for brain Freesurfer, cortical and subcortical structures volumes as well as grey and white matter surface area were calculated for both brain hemispheres. Data were acquired through 3T MRI scanner in the Instituto de Alta Tecnología Médica (IATM) from Medellin (Colombia). Results: There were not statistically significant differences in cortical and subcortical structures between control group and subjects HIV infected with adherence to treatment. Conclusion: These findings show that subjects infectedwith VIH in first or second line of antiretroviral treatment probably do not have any change on the brain cortical and subcortical structures. In addition, this allows developing new neuroprotection and self-care strategies during the current treatment plans.

Importancia de la calidad del informe de alta en la gestión de una unidad clínica quirúrgica / Importance of the quality of the discharge report in the management of a surgical clinical unit

Introducción El informe de alta es un documento básico al finalizar un proceso asistencial, y es un elemento clave en el proceso de codificación. De su correcta redacción, fiabilidad y exhaustividad dependerán los datos que sirvan para determinar la producción hospitalaria. Material y métodos Partimos de la hipótesis de que, analizando la concordancia del informe de alta con los datos cotejados en la documentación del episodio, podremos recodificar todos aquellos casos infracodificados, imputándolos así a un grupo relacionado por el diagnóstico (GRD) más adecuado. Analizamos en 24 pacientes outliers la correcta cumplimentación de tipo y motivo de ingreso, antecedentes personales y medicación, resumen del episodio, diagnósticos principal y secundarios, procedimiento quirúrgico, evolución durante el episodio y número de diagnósticos y procedimientos enumerados, concordancia con la información real del episodio y los cambios teóricos entre los GRD antes y después del análisis. Resultados De 24 casos, 6 informes son válidos y claros; 4, válidos aunque poco claros; 9 son insuficientes y 5, claramente inválidos. La comparación de los GRD recalculados tras la interpretación de los datos del episodio no muestra diferencias significativas, mediante test de Wilcoxon, encontrándose tan solo modificaciones en 5 casos (p = 0,680).Conclusiones La calidad del informe de alta depende de la correcta inclusión de todos los datos del CMBD, en concordancia con el episodio. Las discordancias historia/informe pueden modificar el GRD que, en nuestra serie, no es estadísticamente significativo. La autoauditoría del informe de alta hospitalaria permite establecer líneas de mejora, al disminuir los errores de información (AU)

Background The discharge report is a basic document at the end of a care process, and is a key element in the coding process, since its correct wording, reliability and completeness are factors used to determine the hospital production. Material and methods From a hypothesis based on the analysis of the consistency between the discharge report and data collected from the routine clinical notes during admission, we should be able to re-code all those mis-coded, thus placing them in a more appropriate diagnosis-related group (DRG). A total of 24 patient outliers were analysed for the correct filling in of the type and reason for admission, personal history, medication, anamnesis, primary and secondary diagnosis, sugical procedure, outcome, number of diagnostic and procedures cited, concordance between discharge report and history and recoding of the DRG. Results From a total of 24 episodes, 6 had precise and valid reports, 4 were valid but not precise enough, 9 were insufficient, and 5 were clearly invalid. The recoded DRG after the documentation review was not significantly different, according to the Wilcoxon test, being changed in only 5 cases (P = .680).Conclusion Quality in discharge reports depends on an adequate minimum data set (MDS) in concordance with the source documentation during admission. Discordance can change the DRG, despite it not being significantly different in our series. Self-audit of discharge reports allows quality improvements to be developed along with a reduction in information mistakes (AU)

[Importance of the quality of the discharge report in the management of a surgical clinical unit]. / Importancia de la calidad del informe de alta en la gestión de una unidad clínica quirúrgica.

BACKGROUND: The discharge report is a basic document at the end of a care process, and is a key element in the coding process, since its correct wording, reliability and completeness are factors used to determine the hospital production. MATERIAL AND METHODS: From a hypothesis based on the analysis of the consistency between the discharge report and data collected from the routine clinical notes during admission, we should be able to re-code all those mis-coded, thus placing them in a more appropriate diagnosis-related group (DRG). A total of 24 patient outliers were analysed for the correct filling in of the type and reason for admission, personal history, medication, anamnesis, primary and secondary diagnosis, sugical procedure, outcome, number of diagnostic and procedures cited, concordance between discharge report and history and recoding of the DRG. RESULTS: From a total of 24 episodes, 6 had precise and valid reports, 4 were valid but not precise enough, 9 were insufficient, and 5 were clearly invalid. The recoded DRG after the documentation review was not significantly different, according to the Wilcoxon test, being changed in only 5 cases (P = .680). CONCLUSION: Quality in discharge reports depends on an adequate minimum data set (MDS) in concordance with the source documentation during admission. Discordance can change the DRG, despite it not being significantly different in our series. Self-audit of discharge reports allows quality improvements to be developed along with a reduction in information mistakes.

Resultados a un año tras desarterialización hemorroidal guiada por doppler / One year follow-up after doppler-guided haemorrhoidal artery ligation

Introducción: La desarterialización hemorroidal guiada por doppler (THD) es una técnica no exerética para el tratamiento de las hemorroides, consistente en la ligadura de las ramas distales de la arteria rectal superior. El propósito de este trabajo es evaluar la seguridad y eficacia de esta técnica tras un seguimiento de un año. Material y método Se intervienen 30 pacientes mediante THD por hemorroides sintomáticas grado II o III. La media de edad fue de 49,9 años (30-70 años). En todos se utilizó el dispositivo THD®. Los procedimientos se realizaron bajo anestesia intradural en régimen de corta estancia. Evaluamos tiempo operatorio, dolor, sangrado, estancia postoperatoria, complicaciones y síntomas tras 3-6 y 12 meses. Resultados El tiempo operatorio medio fue de 23 minutos (15-50). El valor de dolor según la escala visual analógica (EVA) fue durante el primer día de 5,5 (el 90% requirió analgesia). Tras el segundo día, sólo 2 pacientes necesitaron analgesia. Un paciente describió dolor persistente hasta los 3 meses, 2 sangrado leve. Una reintervención por trombosis hemorroidal al 10° día. No otras complicaciones. No reingresos. Estancia media: 1,4 días (0-2), y el restablecimiento de actividad diaria normal se realizó a los 7-8 días. 26 pacientes (87%) describen tenesmo, autolimitado en 3 meses. Tras un año, 2 pacientes han sido reintervenidos, 3 han recurrido (2 prolapsos leves y 1 sangrado ocasional). La tasa de resolución total fue del 80%.ConclusionesLa desarterialización hemorroidal guiada por doppler parece ser efectiva tras un año, con un porcentaje de complicaciones bajo (AU)

Introduction: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. Material and method: A total of 30 patients were operated on using DG-HAL for grade II or IIIhaemorrhoids. The mean age was 49.9 years (30-70 years). The THD1 (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. Results: The mean operating time was 23 minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10thday. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. Alarge majority (87%) of patients described having tenesmus, which disappeared in 3months.After one year, two patients had had further operations, 3 had recurrences (2 slightprolapses and 1 occasional bleeding). The success rate was 80%.Conclusions: Haemorrhoidal de arterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications (AU)

[One year follow-up after doppler-guided haemorrhoidal artery ligation]. / Resultados a un año tras desarterialización hemorroidal guiada por doppler.

INTRODUCTION: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. MATERIAL AND METHOD: A total of 30 patients were operated on using DG-HAL for grade II or III haemorrhoids. The mean age was 49.9 years (30-70 years). The THD® (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. RESULTS: The mean operating time was 23minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to 3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10(th) day. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. A large majority (87%) of patients described having tenesmus, which disappeared in 3 months. After one year, two patients had had further operations, 3 had recurrences (2 slight prolapses and 1 occasional bleeding). The success rate was 80%. CONCLUSIONS: Haemorrhoidal dearterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications.

Técnicas básicas de cardiorresonancia / Basic techniques in cardiac MRI

La cardiorresonancia es una alternativa diagnóstica queofrece una valoración del corazón, los órganos adyacentes y lavasculatura torácica con una gran calidad de imagen, convirtiéndolaen una herramienta científica de gran valor en medicina. Esteproceso es realizado por profesionales de la salud, incluyendomédicos y tecnólogos en radiología, responsables de recolectar,confirmar y analizar los datos encontrados en la cardiorresonancia,para culminar en un proceso de valoración anatómica y funcionalde calidad clínica que transciende más allá de la enfermedad,a campos como la investigación y el desarrollo de nuevastecnologías. El presente trabajo pretende mostrar y caracterizarlas técnicas básicas en cardiorresonancia realizadas por un grupo interdisciplinario de médicos, tecnólogos e investigadores conmás de 10 años de experiencia, conviertiendose en un ejerciciode enseñanza y aprendizaje para el profesional clínico, ofreciendoelementos básicos que lo orienten en el análisis e interpretación dela cardiorresonancia.

Cardiac MRI is a diagnostic alternative that offers an evaluation of the heart, adjacent organs and thoracic lavasculature with a high quality of image, making it a scientific tool of great value in medicine. This process is performed by health professionals, including physicians and radiology technologists, responsible for collecting, confirming and analyzing the data found in cardioresonance, to culminate in a process of anatomical and functional evaluation of clinical quality that transcends beyond disease, to Fields such as research and development of new technologies. The present work aims to show and characterize the basic techniques in cardioresonance performed by an interdisciplinary group of physicians, technologists and researchers with 10 years of experience, becoming a teaching and learning exercise for the clinical professional, offering basic elements that guide him in the analysis and Interpretation of cardiac MRI.