Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry.

BACKGROUND AND AIMS: Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs) may be better suited for drainage of dense pancreatic fluid collections (PFCs), such as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior. METHODS: This was a retrospective, noncomparative review of a nationwide database involving all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing PFC drainage with an FCSEMS were included in a database. The main outcome measurements were technical success, short-term (2 weeks) and long-term (6 months) effectiveness, adverse events, and need for surgery. RESULTS: The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term- and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95% CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years) and previous failed drainage were the most important factors associated with negative outcome. CONCLUSIONS: An FCSEMS is effective and safe for PFC drainage. Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS does not seem to influence patient outcome.

Implementation and evaluation of telemedicine in burn care: Study of clinical safety and technical feasibility in a single burn center.

OBJECTIVE: The objective of this study is to review our experience in the implementation of an innovative Telemedicine Platform (the Teleburns Project) for the acute care of burned patients. METHODS: We developed and implemented a Teleburns Platform by the creation of a new medical software and hardware for High Definition medical videoconference, in order to assist distant burned patients. After the establishment of the system and revision of technical requirements, an internal validation of the project was done: we managed 40 consecutive burned patients via telemedicine videoconference within our own Center. Following the internal validation, a pilot test with the Verge de la Cinta Hospital (VCH) - located in Tortosa, 180km away from Barcelona - was conducted. A prospective review of 43 burn patients participating in tele-encounters was performed. The data collected were: patient and injury demographics, need for transfer to our hospital, need for surgical treatment, complications, readmissions and technical problems. RESULTS: No discrepancies were found between remote and face-to-face diagnosis and treatment during internal validation, obtaining a 100% reliability. No technical errors were reported. Concerning the pilot test with the VCH, 43 patients were assessed via telemedicine during a 48-month period. Mean age of the participants was 36.7 (0-85 years). The mean total burn surface area was 3.1% (range 0.5-15%). The more frequently affected areas were head and neck (27 patients) and hands (16 patients). As a result of the 43 televisits, 8 patients (18.6%) were immediately transferred to our Burn Center in Barcelona and 12 patients (27.9%) were asked to come a few days later, to be visited in our Day Care Unit. Thus 23 patients (53.5%) could avoid being transferred to the Burn Center. 5 of them were followed via Teleburns without complications and 17 patients were discharged after the first tele-encounter. All patients discharged presented an uneventful evolution and did not receive further care from our Burn Unit. Technical problems were reported in eleven occasions during this phase, none of which prevented completion of the visits. CONCLUSIONS: The use of Telemedicine for burn assessment can improve the accuracy of burn patients triage, resulting in enhanced resource utilization, time and cost saving for the health system and increased quality of care.

Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients.

Many different surgical techniques are still being used for Dupuytren disease. The outcome of 558 consecutive operations with 1 technique was reviewed. Distinct subgroups were made to detect risk factors for a poor outcome and complications. The mean follow-up time was 7.3 years. Younger patients (first surgery before 45 years) were operated significantly more than older patients (after 45 years). Results of contracted proximal interphalangeal (PIP) joints were significantly worse than other joints. The overall complication rate was 26%. Nerve lesions occurred in 7.7%. Young age proved to be a prognostic factor for the total number of operations. The contracted PIP joints will lead to more complications and poorer result. The risk at nerve lesion, necrosis, and infection are higher for recurrent surgery. These findings can be used in advising patients.