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INTRODUCTION: Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD: This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS: Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS: The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION: This protocol was registered at ClinicalTrials.gov (NCT03105895).
Assuntos
Polímeros de Fluorcarboneto , Hérnia Incisional , Imageamento por Ressonância Magnética , Polivinil , Telas Cirúrgicas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hérnia Incisional/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem , Idoso de 80 Anos ou maisRESUMO
INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was 6,545.90, and the average cost per patient was 10,572.20. DRG 288 represented 91% of the series, with a value of 4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of 4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method.
Assuntos
Custos de Medicamentos/estatística & dados numéricos , Derivação Gástrica/economia , Obesidade/economia , Obesidade/cirurgia , Adulto , Comorbidade , Análise Custo-Benefício , Grupos Diagnósticos Relacionados/normas , Feminino , Seguimentos , Derivação Gástrica/métodos , Humanos , Laparoscopia/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Redução de PesoRESUMO
BACKGROUND: Major impairment of health-related quality of life (HRQoL) is one of the main reasons why obese patients request surgical treatment. OBJECTIVE: To prospectively analyze the impact of HRQoL between obese patients who underwent surgery and those who were wait-listed. METHODS: Between April 2017 and March 2018, 70 surgical and 69 wait-listed patients were interviewed twice, at baseline and at the 12-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL-Lite) questionnaires. Sociodemographic-, clinical-, and surgical-related variables were collected. RESULTS: One hundred thirty-nine patients were analyzed, showing similar baseline characteristics but differences in HRQoL. Performing more qualified work improved scores on some aspects of the SF-12 survey. In contrast, women scored worse on the self-esteem domain, and men scored worse on the mental health domain. By group, at the 12-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P < 0.001) and between baseline and postoperative 12-month follow-up in the surgical group (P < 0.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically significant differences among the Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary Domains (P < 0.05). CONCLUSION: HRQoL is a multimodal concept that allows the identification of factors impacting obese patients' quality of life. It promotes the benefit of surgery against waiting list delays, which can take up to 4 years in our hospital. Therefore, HRQoL is an important pillar to justify more resources for reducing unacceptable surgical delays.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Listas de EsperaRESUMO
INTRODUCTION: Background: evidence from research suggests that the development of cancer disease is associated with environmental factors. There are few studies evaluating nutritional status in women suffering from cancer in Spain. Objectives: this study aimed to assess the nutritional status in breast cancer female patients at diagnosis in a northern region of Spain (Asturias), where breast cancer rates are particularly high when compared to the rest of Spain. Material and methods: a cross-sectional study was conducted in a sample of 76 newly diagnosed female cancer patients. Lifestyle factors, anthropometry, biochemical, and dietary intake data were collected immediately after diagnosis and prior to the initiation of the prescribed treatment. Results: a high percentage of these women diagnosed with cancer were sedentary (59.2%). Their average body mass index (BMI) was 27.3 ± 5.5 kg/m2. They also showed a high percentage of body fat, 38.3%, as well as a large waist circumference of 92.2 cm. Patients reported a low intake of fruits, vegetables, legumes, and nuts, and a high intake of red meat, meat products, and sweet foodstuffs as compared to the Spanish dietary guidelines (p < 0.01). Conclusion: the results showed a low intake of folate, calcium, and vitamin D, which is particularly relevant in women. In conclusion, these breast cancer patients showed overweight and high sedentarism levels, and reported unbalanced dietary patterns at the time of diagnosis.
INTRODUCCIÓN: Introducción: la evidencia actual indica que el desarrollo de algunos tipos de cáncer está asociado a factores ambientales. Pocos estudios realizados en España han evaluado el estado nutricional de las mujeres con cáncer. Objetivos: el objetivo de este estudio ha sido evaluar el estado nutricional de las mujeres en el momento de ser diagnosticadas de cáncer de mama (CM) en una región del norte de España (Asturias), donde las cifras de cáncer de mama son particularmente elevadas en comparación con el resto de España. Material y Métodos: se realizó un estudio transversal con una muestra de 76 mujeres recién diagnosticadas de cáncer de mama. Se recopilaron datos sobre su estilo de vida, antropometría, ingesta, bioquímica y dieta de forma inmediata tras el diagnóstico y antes del inicio del tratamiento. Resultados: un alto porcentaje de estas mujeres diagnosticadas de cáncer eran sedentarias (59,2%). El valor medio de su índice de masa corporal (IMC) era de 27,3 ± 5,5 kg/m2. Asimismo, estas pacientes mostraron un alto porcentaje de grasa corporal, del 38,3%, y un elevado perímetro de la cintura, de 92,2 cm. La dieta de todas las pacientes incluía una escasa ingesta de frutas, verduras, legumbres y frutos secos, y en cambio una ingesta elevada de carnes rojas y procesadas y alimentos dulces, en comparación con las recomendaciones dietéticas españolas (p < 0,01). Conclusión: los resultados mostraron unas escasas ingestas de folato, calcio y vitamina D, particularmente preocupantes en las mujeres. En conclusión, la mayoría de las voluntarias con CM presentaban sobrepeso, altos niveles de sedentarismo y un patrón de dieta no equilibrada en el momento del diagnóstico.
Assuntos
Neoplasias da Mama/fisiopatologia , Avaliação Nutricional , Estado Nutricional , Idoso , Neoplasias da Mama/diagnóstico , Estudos Transversais , Dieta , Feminino , Humanos , Pessoa de Meia-Idade , EspanhaRESUMO
Five-year survival of tumors of the esophagogastric junction is 50%, in the most favourable stages and with the most effective adjuvant treatments. More than 40% of patients will have recurrences within a short period, usually the first year after potentially curative surgery. Survival after this recurrence is usually less than 6 months because treatment is not very effective, be it palliative chemotherapy, radiotherapy or surgical excision of single recurrences. As the detection of asymptomatic recurrences allows for earlier and more effective treatments to be used, the type and frequency of follow-up has an influence on survival.
Assuntos
Adenocarcinoma/mortalidade , Neoplasias Esofágicas/mortalidade , Junção Esofagogástrica , Recidiva Local de Neoplasia/mortalidade , Neoplasias Gástricas/mortalidade , Esôfago de Barrett/complicações , Cárdia , Neoplasias Esofágicas/terapia , Seguimentos , Humanos , Recidiva Local de Neoplasia/terapia , Prognóstico , Neoplasias Gástricas/terapia , Fatores de TempoRESUMO
INTRODUCTION: Peritoneal dialysis has been used in the treatment of end-stage renal disease for a long time. The development of continuous ambulatory peritoneal dialysis (CAPD) has achieved an acceptable device of renal replacement therapy. PRESENTATION OF CASE: We report a 55 year-old patient who was initiated on CAPD in February 2016. Three months later, the Tenckhoff catheter was removed due to its malfunction, and a new self-locating peritoneal dialysis catheter was placed in the left side of the abdomen. In September 2016, the patient presented with symptoms of intestinal obstruction. A CT scan revealed a collapsed sigmoid colon with the tungsten tip of the catheter supported on the mesosigmoid as the cause of the occlusion. DISCUSSION: Herein, a rare but clinically important case of mechanical large bowel obstruction due to self-locating peritoneal dialysis catheter is presented. The weight added to the tip of the self-locating catheter for the purpose of stretching it, can be dangerous if a displacement takes place. A laparoscopic procedure was performed, resolving the obstruction by reinserting the peritoneal catheter in its right position. CONCLUSION: The weight added to the tip of self-locating catheters is a matter of concern, since intimate contact between the peritoneal catheter and the intestinal wall can result in perforation or intestinal occlusion.
RESUMO
Background: evidence from research suggests that the development of cancer disease is associated with environmental factors. There are few studies evaluating nutritional status in women suffering from cancer in Spain. Objectives: this study aimed to assess the nutritional status in breast cancer female patients at diagnosis in a northern region of Spain (Asturias), where breast cancer rates are particularly high when compared to the rest of Spain. Material and methods: a cross-sectional study was conducted in a sample of 76 newly diagnosed female cancer patients. Lifestyle factors, anthropometry, biochemical, and dietary intake data were collected immediately after diagnosis and prior to the initiation of the prescribed treatment. Results: a high percentage of these women diagnosed with cancer were sedentary (59.2%). Their average body mass index (BMI) was 27.3 ± 5.5 kg/m2. They also showed a high percentage of body fat, 38.3%, as well as a large waist circumference of 92.2 cm. Patients reported a low intake of fruits, vegetables, legumes, and nuts, and a high intake of red meat, meat products, and sweet foodstuffs as compared to the Spanish dietary guidelines (p < 0.01). Conclusion: the results showed a low intake of folate, calcium, and vitamin D, which is particularly relevant in women. In conclusion, these breast cancer patients showed overweight and high sedentarism levels, and reported unbalanced dietary patterns at the time of diagnosis
Introducción: la evidencia actual indica que el desarrollo de algunos tipos de cáncer está asociado a factores ambientales. Pocos estudios realizados en España han evaluado el estado nutricional de las mujeres con cáncer. Objetivos: el objetivo de este estudio ha sido evaluar el estado nutricional de las mujeres en el momento de ser diagnosticadas de cáncer de mama (CM) en una región del norte de España (Asturias), donde las cifras de cáncer de mama son particularmente elevadas en comparación con el resto de España. Material y métodos: se realizó un estudio transversal con una muestra de 76 mujeres recién diagnosticadas de cáncer de mama. Se recopilaron datos sobre su estilo de vida, antropometría, ingesta, bioquímica y dieta de forma inmediata tras el diagnóstico y antes del inicio del tratamiento. Resultados: un alto porcentaje de estas mujeres diagnosticadas de cáncer eran sedentarias (59,2%). El valor medio de su índice de masa corporal (IMC) era de 27,3 ± 5,5 kg/m2. Asimismo, estas pacientes mostraron un alto porcentaje de grasa corporal, del 38,3%, y un elevado perímetro de la cintura, de 92,2 cm. La dieta de todas las pacientes incluía una escasa ingesta de frutas, verduras, legumbres y frutos secos, y en cambio una ingesta elevada de carnes rojas y procesadas y alimentos dulces, en comparación con las recomendaciones dietéticas españolas (p < 0,01). Conclusión: los resultados también mostraron unas escasas ingestas de folato, calcio y vitamina D, particularmente preocupantes en las mujeres. En conclusión, la mayoría de las voluntarias con CM presentaban sobrepeso, altos niveles de sedentarismo y un patrón de dieta no equilibrada en el momento del diagnóstico
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/fisiopatologia , Avaliação Nutricional , Estado Nutricional , Neoplasias da Mama/diagnóstico , Estudos Transversais , Dieta , EspanhaRESUMO
La supervivencia a cinco años de los tumores de la unión esofagogástrica está en el 50% en los estadios más favorables y con los tratamientos coadyuvantes más eficaces. Más del 40% de los pacientes sufrirá recurrencias en un periodo breve, habitualmente en el primer año tras una cirugía potencialmente curativa y la supervivencia tras esa recurrencia suele ser menor de 6 meses, pues el tratamiento es poco eficaz, sea quimioterapia paliativa, radioterapia o exéresis quirúrgica de las recidivas únicas. El tipo y frecuencia del seguimiento realizado influye en la supervivencia porque la detección de recurrencias asintomáticas permite realizar tratamientos más precoces y efectivos
Five-year survival of tumors of the esophagogastric junction is 50%, in the most favourable stages and with the most effective adjuvant treatments. More than 40% of patients will have recurrences within a short period, usually the first year after potentially curative surgery. Survival after this recurrence is usually less than 6 months because treatment is not very effective, be it palliative chemotherapy, radiotherapy or surgical excision of single recurrences. As the detection of asymptomatic recurrences allows for earlier and more effective treatments to be used, the type and frequency of follow-up has an influence on survival
Assuntos
Humanos , Adenocarcinoma/mortalidade , Neoplasias Esofágicas/mortalidade , Junção Esofagogástrica , Recidiva Local de Neoplasia/mortalidade , Neoplasias Gástricas/mortalidade , Esôfago de Barrett/complicações , Cárdia , Neoplasias Esofágicas/terapia , Seguimentos , Recidiva Local de Neoplasia/terapia , Prognóstico , Neoplasias Gástricas/terapia , Fatores de TempoRESUMO
No disponible
Assuntos
Humanos , Idoso , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hiperostose Esquelética Difusa Idiopática/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCCIÓN: La cirugía bariátrica es el mejor tratamiento de la obesidad mórbida a largo plazo. El ahorro generado por la mejoría de las comorbilidades podría justificar el empleo de más recursos sanitarios. MÉTODOS: Estudio observacional, descriptivo, longitudinal y retrospectivo, de pacientes a los que se les realizó un bypass gástrico, en el Hospital Universitario Central de Asturias entre 2003 y 2012. El seguimiento mínimo se estableció en dos años. Calculamos de manera individualizada el coste para cada uno de los pacientes intervenidos (bottom-up), así como según el grupo relacionado por el diagnóstico (GRD) (top-down). RESULTADOS: De los 307 pacientes del estudio, el coste medio del ingreso calculado por GRD fue de 6.545,9 y el calculado por paciente de 10.572,2. El GRD 288 representa al 91% de la serie con un valor de 4.631. El cálculo estimativo del ahorro que supuso en nuestro entorno sanitario la disminución del número de fármacos de 2,86 a 0,78 por paciente medicado, representó 4.433 por paciente intervenido si padecía todas las comorbilidades analizadas. CONCLUSIONES: El bypass gástrico en el Hospital Universitario Central de Asturias a los dos años de la cirugía, en pacientes con pluripatología consiguió un ahorro solo en fármacos que podría compensar los gastos inherentes al tratamiento quirúrgico. El coste por proceso mediante GRD se mostró insuficiente a la hora de hacer una correcta evaluación económica, por lo que recomendamos un método de evaluación de coste por paciente
INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was 6,545.90, and the average cost per patient was 10,572.20. DRG 288 represented 91% of the series, with a value of 4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of 4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method