Planificación pre-operatoria digital en artroplastia total de cadera / Digital templating in total hip arthroplasty

Introducción: La planificación preoperatoria favorece la realización de un acto quirúrgico sin complicaciones. Actualmente existe escasa información a nivel nacional sobre la eficacia de la planificación pre-operatoria digital por lo que el objetivo del presente estudio es el analizar los resultados de la implementación de esta estrategia en una población de pacientes con indicación de artroplastia total de cadera. Materiales y métodos: Estudio observacional, prospectivo, analítico. Se realizó un muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes >18 años con indicación de ATC, entre diciembre 2018 ­ octubre 2019, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Se utilizó el software TraumaCad® versión 2.5 de Brainlab y marcadores radiológicos King Mark®. Fueron comparados ambos tipos de planificación ejecutando análisis estadísticos con el software R.v3.4.2., siendo un valor p ˂0.05, considerado estadísticamente significativa. Resultados: 57 pacientes fueron evaluados con el método digital y los resultados fueron comparados con los de 42 pacientes en los que se utilizó una planificación manual. La relación masculino-femenino fue 1/1, siendo los del grupo de 50 a 60 años, los más afectados. La coxartrosis primaria y la necrosis ósea aséptica fueron los diagnósticos más frecuentes. El tiempo quirúrgico, la correlación entre planificación y resultados para componentes acetabular, femoral, presentaron mejores resultados en el grupo de pacientes con planificación digital. Conclusión: La planificación digital comparada con la manual presentó mayor eficacia.

Introduction: Preoperative planning allows a surgical act without complications. It can be manual or digital. Its usefulness in total hip arthroplasty (ATC) is important, being digital seemingly more beneficial since it reduces surgical time and complications. The present study analyzed the effectiveness of the digital modality. Materials and methods: Observational, prospective, analytical study. Non-probabilistic sampling of consecutive cases attended in Department of Orthopedics and Traumatology of the Medicine Scholl (Universidad Nacional de Asunción). Patients> 18 years of age were indicated with ATC indication, between december 2018 to october 2019, with prior informed consent. Data whose characterization was made possible by means of a previously established instrument, entered in Excel basis, were released. Each patient had both types of planning: manual and digital. For TraumaCad® version 2.5 Brainlab software and King Mark® radiological markers were used for the digital. Both types of planning were compared by executing statistical analyzes with the software R.v3.4.2., being a value p <0.05, considered statistically significant. Results: 57 patients were evaluated with the digital method and 42 with the manual. The male-female ratio was 1/1, with those in the 50-60 age group being the most affected. The most frequent reason for consultation was hip pain, with primary coxarthrosis and aseptic bone necrosis being their cause. The consultation time 1 and surgery was 12.5 days. The surgical time, the correlation between planning and results for acetabular, femoral components, were more effective with digital planning. Conclusion: Digital planning compared to the manual is more effective.

Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma

OBJECTIVES: Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors. METHODS: Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis. RESULTS: Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6+/-1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32+/-0.18 cm) than the primary tumors (0.63+/-0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors. CONCLUSION: In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up.

Preoperative Localization of Early Colorectal Cancer or a Malignant Polyp by Using the Patient's Own Blood

PURPOSE: Preoperative localization is the most important preparation for laparoscopic surgery. Preoperative marking with India ink has widely been used and is considered to be safe and effective. However, India ink can cause significant inflammation, adhesions and bowel obstruction. Therefore, we have used the patient's blood instead of the ink since 2011. In this retrospective study, we wanted to examine the feasibility of preoperative localization by using the patient's blood. METHODS: Twenty-five patients who underwent preoperative localization in which 10 mL of their own venous blood was used as a tattooing agent were included in this study. The characteristics of the patients, the anatomy of the colon cancer, and the efficacy and the side effects of using this procedure were analyzed. RESULTS: In 23 cases (92%), through the laparoscope, we found perfectly localized bloody smudges in the serosa. However, in 2 cases (8%), we could not find the exact location of the lesion. No patients showed any complications. CONCLUSION: Preoperative localization of early colon cancer or a malignant polyp by using patient's blood is feasible, safe and simple. We think that using the patient's blood for localization of a lesion is better than using some other foreign material such as India ink.