Reversible Homonymous Inferior Quadrantanopia in a Nonketotic Hyperglycemic Patient.

Homonymous hemianopia is frequently associated with retrochiasmal lesions. Vascular etiology is the most common and usually evident on magnetic resonance imaging. When the results of neuroimaging are normal, there are other etiologies that we should consider, like nonketotic hyperglycemia (NKH). We report a 62-year-old female diabetic patient with headache, colour vision and sudden homonymous inferior quadrantanopia and elevated blood sugar levels with normal pH. The neuroimaging was normal and the visual lost improved after the correction of the hyperglycemia. NKH should be considered in patients with sudden and transient hemianopia and normal neuroimaging.

Resultados de la implantación de un protocolo de corrección de anemia preoperatoria en la recuperación intensificada de cirugía colorrectal electiva / Results of the implantation of a protocol for correction of preoperative anemia in the intensified recovery of elective colorectal surgery

Resumen Introducción Los protocolo ERAS recomiendan la detección y optimización de la anemia preoperatoria. Objetivo Evaluar si la implantación de un protocolo de corrección de anemia preoperatoria en cirugía colorrectal electiva con un protocolo ERAS (grupo ERAS) reduce las transfusiones con respecto a un grupo de pacientes operado de la misma patología previo a su implantación (grupo preERAS). Objetivos secundarios Valorar estancia hospitalaria, complicaciones y reingresos a los 30 días tras el alta. Materiales y Método Comparamos los primeros 121 pacientes consecutivos que participaron en un protocolo ERAS con un protocolo corrección de anemia preoperatoria con los 135 previos a su implantación. Se consideraron resultados significativos p < 0,05. Resultados Se redujo el número de pacientes transfundidos en el grupo ERAS (31 (22,96%) vs 15 (12,4%), p = 0,028) y el número total de concentrados de hematíes transfundidos (3 ± 1,57 vs 1,8 ± 0,56, p < 0,001) con la aplicación del protocolo. No se encontraron diferencias estadísticamente significativas en los pacientes que recibieron hierro oral, pero sí en los que recibieron hierro intravenoso (3 vs 31, p < 0,001). Se redujo la estancia hospitalaria (11 ± 3,8 vs 9,8 ± 3,7, p = 0,018), sin aumentar la tasa de complicaciones ni los reingresos a los 30 días. Conclusión La aplicación de un protocolo de optimización de anemia preoperatoria en pacientes sometidos a cirugía colorrectal electiva siguiendo las guías ERAS redujo el número total de pacientes transfundidos, el número de concentrados de hematíes trasfundidos y la estancia hospitalaria.

Introduction An enhanced recovery after surgery (ERAS) protocol, recommends detection and optimization in treatment of preoperative anemia. Aim Evaluate if introducing a preoperative anemia correcting protocol in elective colorectal surgery, by means of an ERAS protocol (ERAS Group), reduces the need for transfusions with regards to a group of patients undergoing surgery for the same pathology before the protocol´s implementation (ERAS Group). Secondary objectives Evaluate length of stay, complications and readmission rates 30 days post discharge. Materials and Method We compared the first 121 consecutive patients who participated in an ERAS protocol with a preoperative correcting anemia protocol, with the previous 135 patients operated on before the protocol was introduced. A value of p < 0.05 was considered significant. Results The number of patients who needed a transfusion was reduced in the ERAS group (31 (22.96%) vs 15 (12.4%), p = 0.028) as was the total number of red blood cells transfused (3 ± 1.57 vs 1.8 ± 0.56, p < 0.001) with the use of the protocol. No statistical differences were noted in the patients who received oral iron although there was in those who received intravenous iron. (3 vs 31, p < 0.001). Overall length of stay was reduced (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), but no increase in complications or readmission rates at 30 days. Conclusions The implementation of an optimization in the treatment of preoperative anemia protocol in patients undergoing elective colorectal surgery following the ERAS guidelines, reduced the total number of patients who needed transfusions, the total concentrate of red blood cells transfused, and the length of stay.

Clasificación del patrón transversal de las fracturas de la cabeza del radio tipo Mason II y su utilidad en la osteosíntesis mediante técnica artroscópica. Estudio anatomoquirúrgico / Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study

Objetivo: La reducción y fijación de la fractura de la cabeza del radio tipo MasonII asistida por artroscopia es una técnica válida que proporciona buenos resultados. El objetivo de este estudio es llamar la atención sobre la utilidad de la localización de la fractura en la cabeza del radio en cuadrantes definidos con respecto a la tuberosidad bicipital mediante la TC. Ello ayudaría a planificar la posición del antebrazo óptima para acceder a cada cuadrante y prever las dificultades específicas de cada uno. Material y método: Se ha procedido a la disección de 4 especímenes de cadáver criopreservado. Hemos dividido la cabeza del radio en 4 cuadrantes con respecto a la tuberosidad bicipital objetivando el cambio de posición en pronación y en supinación máxima con respecto a la cavidad sigmoidea menor y a las estructuras neurovasculares. Resultados: La cabeza del radio se desplaza con la pronosupinación, por lo que existen áreas de convergencia entre los distintos cuadrantes. El cuadrante1 se aborda en supinación por un portal anteromedial. El cuadrante2 se aborda en pronación máxima mediante un portal lateral. El cuadrante3 se puede abordar a través de portales laterales, con el antebrazo en posición neutra y en pronación. El cuadrante4 es accesible con el antebrazo en posición neutra y en supinación a través de un portal lateral. Conclusiones: Según la localización de la fractura en la cabeza del radio con respecto a la tuberosidad bicipital, necesitaremos acceder por un portal artroscópico determinado, siendo los cuadrantes mediales (anteromedial y posteromedial) los más exigentes técnicamente

Objective: The management of MasonII fracture pattern assisted by arthroscopy is a valid technique that provides good results. The objective of this study was to draw attention to the usefulness of the location of the fracture in the head of the radius in defined quadrants with respect to the bicipital tuberosity through CT. This would help to plan the optimal forearm position to access each quadrant and foresee the specific difficulties of each one. Material and method: We dissected 4 specimens of cryopreserved cadaver. We divided the radial head into 4 quadrants with regard to the bicipital tuberosity, objectifying the change of position in pronation and maximum supination with respect to the sigmoid cavity and neurovascular structures. Results: The head of the radio moves with pronosupination, so there are areas of convergence between the different quadrants. Quadrant1 is approached in supination via an anteromedial portal. Quadrant2 is approached in maximum pronation through a lateral portal. Quadrant3 can be approached through lateral portals, with the forearm in neutral position and in pronation. Quadrant4 is accessible with the forearm in a neutral position and in supination through a lateral portal. Conclusions: Depending on the location of the fracture in the head of the radius with respect to the bicipital tuberosity, we will need access through a specific arthroscopic portal, with the medial quadrants (anteromedial and posteromedial) being the most technically demanding

Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study. / Clasificación del patrón transversal de las fracturas de la cabeza del radio tipo Mason II y su utilidad en la osteosíntesis mediante técnica artroscópica. Estudio anatomoquirúrgico.

OBJECTIVE: The management of MasonII fracture pattern assisted by arthroscopy is a valid technique that provides good results. The objective of this study was to draw attention to the usefulness of the location of the fracture in the head of the radius in defined quadrants with respect to the bicipital tuberosity through CT. This would help to plan the optimal forearm position to access each quadrant and foresee the specific difficulties of each one. MATERIAL AND METHOD: We dissected 4 specimens of cryopreserved cadaver. We divided the radial head into 4 quadrants with regard to the bicipital tuberosity, objectifying the change of position in pronation and maximum supination with respect to the sigmoid cavity and neurovascular structures. RESULTS: The head of the radio moves with pronosupination, so there are areas of convergence between the different quadrants. Quadrant1 is approached in supination via an anteromedial portal. Quadrant2 is approached in maximum pronation through a lateral portal. Quadrant3 can be approached through lateral portals, with the forearm in neutral position and in pronation. Quadrant4 is accessible with the forearm in a neutral position and in supination through a lateral portal. CONCLUSIONS: Depending on the location of the fracture in the head of the radius with respect to the bicipital tuberosity, we will need access through a specific arthroscopic portal, with the medial quadrants (anteromedial and posteromedial) being the most technically demanding.

Proceso de atención integrada para niños con necesidades especiales (PAINNE) / Process for integrated care for children with special needs (PAINNE)

Introducción y objetivos: la prevención de las deficiencias infantiles resulta más eficiente cuando coordinamos recursos, implicamos a los profesionales e incorporamos herramientas para la detección e intervención temprana en las deficiencias infantiles y en situaciones de riesgo biológico, psicológico y/o social. Material y métodos: presentamos los primeros resultados de la implantación del Proceso de atención integrada en niños con necesidades especiales (PAINNE), de la Organización Sanitaria Integrada Bilbao-Basurto (Bilbao, España), siguiendo el modelo de atención temprana del País Vasco, en una población de 20 655 menores de seis años. Aplicando metodología cualitativa, incorporamos nuevos datos básicos del paciente sobre desarrollo infantil en la historia clínica electrónica, junto con los indicadores del proceso, recogidos en la guía PAINNE 2013. Resultados: el 75% de los pediatras y el 56% de los profesionales de enfermería participaron previamente en actividades de formación en atención temprana. Las propuestas desde los equipos de Pediatría se validaron por el equipo técnico de valoración en atención temprana de la Diputación Foral de Bizkaia (EVAT), en el 93,27% de los casos. La edad media de derivación a salud mental infantil descendió en ocho meses, hasta los tres años, en casos de enfermedad mental grave, mejorando el diagnóstico precoz y el inicio de los programas de intervención. Conclusiones: los resultados obtenidos en el primer año indican que los equipos de Pediatría se consolidan como gestores válidos de 516 niños con necesidades especiales de salud en programas de atención temprana entre 0 y 6 años (AU)

Introduction and objectives: the prevention of childhood deficits is more efficient when resources are coordinated amongst the professionals responsible for the child's care and screening tools are utilized to detect and provide early intervention to address situations of biological, psychological, and/or social risk. Material and methods: we present the initial results of the implementation of the process for integrated care for children with special needs, PAINNE, in the integrated health organization Bilbao-Basurto, following the model of early intervention in the Basque Country, with a population of 20 655 children under the age of 6 years old. Applying the qualitative methodology, we have incorporated developmental screening tools in the electronic medical record, along with the other process indicators, as described in the guide PAINNE 2013. Results: 75% of the pediatricians and 56% of the nurses participated in continuing educational activities regarding early intervention. The referrals for early intervention were accepted in 93.27% of the cases by the Basque Early Intervention Team (EVAT). The median age for referral to mental health services for children with severe mental health problems decreased by 8 months to 3 years old, showing improvement in the early detection and implementation of services. Conclusions: the results obtained in the first year indicated that the Pediatric Primary Care teams have reliably identified and referred 516 children with special needs, ages 0-6 years, to early intervention programs (AU)

Micro-ureteroscopia: Experiencia inicial en el tratamiento endoscópico de litiasis de uréter pelviano / Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis

Objetivos: Presentar el primer caso de litiasis ureteral resuelto mediante un nuevo abordaje endoscópico que denominamos micro-ureteroscopia (m-URS) y que pretende reducir el daño ureteral que se produce por el instrumental convencional. Material y métodos: Seleccionamos a una paciente de 53 años de edad con una litiasis de 16 mm en el uréter distal derecho. Para el acceso endoscópico empleamos la vaina de 4,8 Fr del set de micro-Perc y fragmentamos la litiasis con una fibra láser de 230 μ. Resultados: Se consiguió la fragmentación por completo de la litiasis. Colocamos un catéter JJ debido al importante edema ureteral. El tiempo quirúrgico fue de 156 min y la estancia posquirúrgica de 24 h. No hubo complicaciones, los requerimientos de analgesia fueron mínimos y la paciente quedó libre de litiasis residuales. Conclusiones: La m-URS es una técnica factible, sencilla y eficaz en el tratamiento de litiasis ureteral pelviana en mujeres, que optimiza la mínima invasión con unos resultados que pueden ser equiparables a las técnicas endoscópicas convencionales en cuanto a la facilidad del acceso y la calidad de visión endoscópica sin afectar la capacidad resolutiva. Se requiere de estudios más potentes y de un mayor desarrollo tecnológico para definir el rol definitivo de este procedimiento. Las mayores limitaciones actuales residen en el tratamiento de litiasis en el uréter proximal o en varones. Podría ser una buena alternativa también en pacientes pediátricos

Objectives: To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. Material and methods: We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. Results: Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156 minutes and 24 hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. Conclusions: The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients

Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis.

OBJECTIVES: To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. MATERIAL AND METHODS: We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. RESULTS: Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156minutes and 24hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. CONCLUSIONS: The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients.

Unidad de Neonatología del Hospital Universitario Basurto / Neonatology Unit of the University Hospital of Basurto

En este artículo se describe la organización y gestión de la Unidad Neonatal del H.U. Basurto, resaltando su misión, visión y valores, y se definen sus objetivos y líneas estratégicas. Se presenta una breve descripción de la Unidad Neonatal, se resume su cartera de servicios y se aportan algunos datos referentes a su actividad asistencial, docente, de investigación, gestión y calidad (AU)

Present article describes the organization and management of Neonatal Unit at Basurto University Hospital, drawing particular attention to its mission, vision and values, and defines its objectives and strategic plans. It briefly describes the Neonatal Unit, summarizes its service portfolio and provides some data concerning assistance activity, docent assigment, research, management and excellence (AU)

Tratamiento de las complicaciones hemorrágicas de la nefrolitotomía percutánea en posición de Galdakao / Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position

Objetivo: La nefrolitotomía percutánea (NLPC) es una técnica con buenos resultados para el tratamiento de la litiasis renal, sin embargo, las complicaciones hemorrágicas derivadas de la misma puedes ser graves si no son diagnosticadas y tratadas eficazmente. El objetivo de este estudio es evaluar las complicaciones hemorrágicas derivadas de la nefrolitotomía percutánea en posición de Galdakao y su manejo terapéutico. Material y métodos: Estudio longitudinal retrospectivo de 172 NLPC realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011, analizando sus complicaciones hemorrágicas y el tratamiento establecido para su resolución. Resultados: Presentaron complicaciones hemorrágicas 20 pacientes (11,6%). El requerimiento transfusional de esta serie fue de 8,1% y la causa más frecuente de transfusión el hematoma perirrenal post-operatorio (7,5%). Hubo 6 lesiones arteriales (3,5%), 5 de ellas tratadas satisfactoriamente con arteriografía y embolización selectiva de la lesión. Conclusiones: Las lesiones arteriales por NLPC son poco frecuentes pero pueden ser graves. La posibilidad de realizar de manera urgente arteriografía y embolización selectiva, ante el diagnóstico de una lesión vascular tras NLPC, permite el tratamiento de la hemorragia de una manera eficaz y segura sin riesgo para la unidad renal afectada (AU)

Objetive: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. Material and methods: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. Results: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. Conclusions: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit (AU)

Estudio de factores predictivos para complicaciones tras nefrolitotomía percutánea ajustado a la clasificación de Clavien / Study of Predictive Factors for Complications After Percutaneous Nephrolithotomy According to the Clavien Classification

Objetivo: Establecer factores predictivos de complicaciones en nefrolitotomía percutánea (NLPC) utilizando el sistema de Clavien modificado. Material y método: Estudio retrospectivo en el que se incluyen 172 NLPC en posición de Galdakao realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011. Se clasifican las complicaciones derivadas de estos procedimientos utilizando el sistema de Clavien modificado. Se realiza un análisis univariante (test Chi-cuadrado y V de Cramer) y multivariante (regresión logística) de factores predictivos de estas complicaciones (p < 0,05). Resultados: En 49 de los 172 procedimientos se detectaron complicaciones (28,5%). Las complicaciones más frecuentes fueron de grado 1 (9,9%), 12 complicaciones (6,9%) fueron clasificadas como grado 2 por requerir tratamiento médico adicional, 6 como grado 3A (3,5%), 7 como grado 3B (4,1%), 2 como 4A (1,1%), 4 como 4B (2,3%) y una como 5 (0,6%). En el análisis univariante el cultivo de orina positivo previo a la intervención, las litiasis complejas y el tamaño mayor de 40 mm de las mismas mostraron una asociación estadísticamente significativa con la aparición de complicaciones (p < 0,05). El cultivo positivo (OR: 2,96) y las litiasis complejas (OR: 3,03) demostraron ser variables independientes de predicción de complicaciones en el análisis multivariante. Conclusiones: El sistema de Clavien permite utilizar un lenguaje común para clasificar las complicaciones, expresando el grado de las mismas según la complejidad del tratamiento requerido para su resolución. La positividad del urinocultivo preoperatorio y las litiasis complejas demostraron ser factores predictivos de estas complicaciones en nuestra serie (AU)

Objective: Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system. Material and methods: Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi2 Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P <0 .05). Results: In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis. Conclusions: Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie (AU)

Study of predictive factors for complications after percutaneous nephrolithotomy according to the Clavien classification.

OBJECTIVE: Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system. MATERIAL AND METHODS: Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi(2) Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P < .05). RESULTS: In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis. CONCLUSIONS: Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie.

Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position.

OBJECTIVE: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. MATERIAL AND METHODS: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. RESULTS: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. CONCLUSIONS: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit.

Tratamiento quirúrgico de la litiasis en riñón en herradura / Surgical Therapy of Lithiasis in Horseshoe Kidney

Objetivo: Presentar la experiencia de nuestro centro en el tratamiento quirúrgico de la litiasis en pacientes con riñón en herradura. Material y métodos: Desde octubre de 2007 hasta septiembre de 2011 hemos tratado 10 pacientes con litiasis en riñón en herradura. De forma retrospectiva hemos revisado sintomatología, antecedentes médicos y quirúrgicos, características de la litiasis (tamaño, localización y composición) y tratamientos realizados. En todos los casos se realizó estudio mediante TC con reconstrucción volumétrica y estudio angiográfico. Se realizó nefrolitotomía percutánea (NLPC) o cirugía endoscópica retrógrada intrarrenal (CRIR) en función del tamaño y localización de la litiasis. Resultados: Se han realizado tres nefrolitotomías percutáneas (dos coraliformes completas, una pseudocoraliforme) con un solo acceso combinando nefroscopia rígida y flexible. En un caso se produjo hemorragia que requirió embolización selectiva. En el resto se realizó CRIR, todos con litiasis de < 30 mm de diámetro mayor, sin ninguna complicación. Los tiempos quirúrgicos medios fueron de 120 (60-180) minutos para la vía percutánea y de 105 minutos (65-160) para la retrógrada. En todos los casos el tratamiento consiguió la eliminación completa de la litiasis o restos de menos de 5 mm. Conclusiones: El tratamiento de la litiasis en los riñones en herradura es complejo, dada la peculiar anatomía. Las técnicas quirúrgicas habituales permiten en estos casos buenos resultados. Optamos por NLPC en coraliformes completos y pseudocoraliformes, siendo la CRIR una opción válida en casos con tamaño litiásico < 3 cm (AU)

Objective: To present our centre‘s experience in the surgical treatment of lithiasis in patients with horseshoe kidney. Material and methods: From October 2007 to March 2011 we treated 10 patients with renal lithiasis in their horseshoe kidneys. Retrospectively, we reviewed the symptoms, medical and surgical history, the characteristics of the stones (size, location, composition) and treatments that were carried out. In all the cases, the study was carried out by CT, with volume reconstruction and with an angiographic study. A percutaneous nephrolithotomy (PCNL) or an endoscopic retrograde intrarrenal surgery (RIRS) was carried out, depending on the size and location of the stone. Results: Three percutaneous nephrolithotomies were carried out (2 on staghorn lithiasis stones, 1 pseudocoraliform stone) with a combined rigid and flexible single-access nephroscopy. In one case there was haemorrhage that required treatment by selective embolization. In the rest, RIRS was carried out, all with stones < 30 mm in their greatest diameter without any complications. The mean surgical times were 120 (60-180) minutes for the percutaneous route and of 105 (65-160) minutes for the retrograde route. In all the cases the treatment achieved a complete elimination of the stones or remains of less than 5 mm. Conclusions: The treatment of renal lithiasis in horseshoe kidneys is complex, given their peculiar anatomy. The usual surgical techniques can be reproduced in these cases with good results. We opt for PCNL in complete staghorn stone and pseudocoraiform stones, whereas RIRS is a valid option in cases with stones < 3 cm (AU)

[Surgical therapy of lithiasis in horseshoe kidney]. / Tratamiento quirúrgico de la litiasis en riñón en herradura.

OBJECTIVE: To present our centre's experience in the surgical treatment of lithiasis in patients with horseshoe kidney. MATERIAL AND METHODS: From October 2007 to March 2011 we treated 10 patients with renal lithiasis in their horseshoe kidneys. Retrospectively, we reviewed the symptoms, medical and surgical history, the characteristics of the stones (size, location, composition) and treatments that were carried out. In all the cases, the study was carried out by CT, with volume reconstruction and with an angiographic study. A percutaneous nephrolithotomy (PCNL) or an endoscopic retrograde intrarrenal surgery (RIRS) was carried out, depending on the size and location of the stone. RESULTS: Three percutaneous nephrolithotomies were carried out (2 on staghorn lithiasis stones, 1 pseudocoraliform stone) with a combined rigid and flexible single-access nephroscopy. In one case there was haemorrhage that required treatment by selective embolization. In the rest, RIRS was carried out, all with stones < 30 mm in their greatest diameter without any complications. The mean surgical times were 120 (60-180) minutes for the percutaneous route and of 105 (65-160) minutes for the retrograde route. In all the cases the treatment achieved a complete elimination of the stones or remains of less than 5 mm. CONCLUSIONS: The treatment of renal lithiasis in horseshoe kidneys is complex, given their peculiar anatomy. The usual surgical techniques can be reproduced in these cases with good results. We opt for PCNL in complete staghorn stone and pseudocoraiform stones, whereas RIRS is a valid option in cases with stones < 3 cm.

Tratamiento de las luxaciones acromioclaviculares agudas de tipo iii de la clasificación de Rockwood con placa gancho AO / Treatment of type iii acute acromioclavicular joint dislocations according to the Rockwood classifications with AO hook plate

Objetivo: Valorar los resultados funcionales y radiológicos a corto plazo de la utilización de la placa gancho AO en el tratamiento quirúrgico de las luxaciones acromioclaviculares (AC) agudas de tipo iii. Material y método: Durante el período 2006–2008 se han realizado 70 intervenciones por lesiones (fracturas y luxaciones) de la clavícula, 26 de ellas luxaciones AC agudas o crónicas. Hemos analizado los resultados de las luxaciones agudas tratadas con una placa gancho AO. Material y método: La serie constaba de 11 luxaciones AC de tipo iii, con una edad media de 38 años. En 6 casos ocurrieron por accidente de tráfico y en 5 casos ocurrieron por etiología laboral. La media de la retirada de la placa fue a las 9 semanas (rango de 6–12semanas). Resultados: Los resultados funcionales de la serie según el test de Constant fueron de 94 puntos de media y la escala analógica visual fue de 2,1. El tiempo medio hasta la cirugía de las luxaciones agudas fue de 9 días. Todos los pacientes, menos uno, presentaban molestias subacromiales durante la fisioterapia y que desaparecieron al retirar la placa. Hemos observado un caso de pérdida de reducción tras la retirada de la placa y no hemos observado otras complicaciones significativas. Conclusiones: El tratamiento quirúrgico de las luxaciones AC agudas con la placa gancho AO, sin la reconstrucción del los ligamentos coracoclaviculares, ofrece un buen resultado. Hemos observado pocas complicaciones y ha permitido la reincorporación laboral de los pacientes sin secuelas (AU)

Purpose: Assess the short term functional and radiological results of using the AO hook plate in type III acute acromioclavicular joint dislocations. Materials and Methods: During the 2006–2008 period, we performed 70 interventions due to injuries (fractures and dislocations) of the clavicle, 26 of them being acute or chronic acromioclavicular joint dislocations. We analyzed the results of 11 acute cases treated with an AO hook plate. This group had an average age 38 years, 6 cases due to traffic accidents and 5 were related to accidents at work. The plate was with drawn at an average of 9 weeks (range 6–12 weeks). Results: The functional outcome of the series according to the Constant test of acute AC joint dislocations was a mean of 94 with the score on the VAS of 2.1. Average time to surgery for acute joint dislocations was 9 days. All the patients, except for one, had subacromial physical discomfort during physiotherapy with the abducted arm that disappeared after removing the plate. We observed a case of loss of reduction after removal of plate and did not observe any other significant complications. Conclusions: Surgical treatment of acute AC joint dislocations with AO hook plate, without reconstruction of the coracoclavicular ligaments, offers good results. We observed few complications, allowing the patients to return to work early without sequels (AU)

[An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period]. / Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005).

INTRODUCTION: The research on critical care nursing is generally presented in the annual national congresses of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC). This study has aimed to analyze the main features of the papers presented in the above-mentioned congresses in order to get a deeper knowledge of the research capacity of our professional group. MATERIALS AND METHODOLOGY: A descriptive, observational and retrospective study. SAMPLE: all the papers. Dimension studied: structure and process. Time: 8 years. DATA SOURCE: a collection of the papers presented in congresses. DEVELOPMENT: collected variables: number of authors, type of paper, city and region, type of study, timing, nursing role, dimension analyzed, topic, hospital, department, type of statistics, relevance, financing, structural quality and others. Statistical processing: descriptive statistics for quantitative variables with means and standard deviation (SD); qualitative variables are written in percentages. We have contrasted hypotheses with chi(2) accepting if p < 0.05 as a statistical significance. RESULTS: Papers 736 (65-119), oral papers 270 (40.4%), mean of authors 4.87 (1-16), SD 1.97; per provinces: Barcelona 146 (19.8%); per autonomous communities: Catalonia 166 (22.6%); hospitals: University Hospital from Bellvitge 27 (4.2%); research studies 426 (65.3%); prospective studies 333 (51%), quantitative 345 (53%); with descriptive statistics 305 (46.9%); with a health perception and health management pattern 76 (10.3%); analyzed quality area: structure 379 (51.5%); with the presence of an autonomous role 380 (51.6%); most mentioned theme: respiratory care 100 (13.6%), with relevance and/or applicability 450 (69%); financed 23 (3.5%). Fulfillment of scientific structure: 97%. CONCLUSIONS: Intensive Nursing Care shows an important amount of oral papers. Research studies stand out among these papers, the former having high structural quality and relevance and/or applicability.

Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005) / An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period

Introducción. La investigación en enfermería decuidados críticos suele comunicarse en los congresosnacionales de la Sociedad Española de EnfermeríaIntensiva y Unidades Coronarias (SEEIUC) que serealiza anualmente. El objetivo de este estudio esanalizar las características principales de lascomunicaciones presentadas en este evento paraconocer en profundidad la capacidad investigadoradel colectivo.Material y método. Estudio descriptivo,observacional y retrospectivo. Muestreo: todas lascomunicaciones. Dimensión estudiada: estructura yproceso. Tiempo: 8 años. Fuente de datos: libros decomunicaciones. Desarrollo: las variables recogidasfueron el número de autores, tipo de comunicación,ciudad y región, tipo de estudio, temporalidad, rol deenfermería, dimensión estudiada, tema, hospital,servicio, tipo de estadística, relevancia, financiación,calidad estructural y otros. Procesamiento estadístico:estadística descriptiva para variables cuantitativas conmedias y desviación estándar (DE), las cualitativas seexpresan en porcentajes. Contrastes de hipótesis con X2 aceptando significación estadística si p < 0,05.Resultados. Comunicaciones 736 (65-119), enformato oral 270 (40,4%); media de autores 4,87 (1-16), DE 1,97; por provincias: Barcelona 146 (19,8%);por Comunidades: Cataluña 166 (22,6%); hospitales:Hospital Universitario de Bellvitge 27 (4,2%); estudiosde investigación 426 (65,3%); prospectivas 333(51%); cuantitativas 345 (53%); con estadísticadescriptiva 305 (46,9%); patrón percepción-manejode la salud 76 (10,3%); área de calidad estudiada:estructura 379 (51,5%); presencia de rol autónomo380 (51,6%); tema más referenciado: los cuidadosrespiratorios 100 (13,6%); con relevancia y/oaplicabilidad 450 (69%); financiadas 23 (3,5%).Cumplimiento de estructura científica: 97%.Conclusiones. La enfermería de cuidados críticospresenta un número importante de comunicacionesorales, con predominio de estudios de investigacióncon una calidad estructural alta, y con relevancia y/oaplicabilidad

Introduction. The research on critical care nursingis generally presented in the annual nationalcongresses of the Spanish Society of IntensiveNursing and Coronary Units (SEEIUC). This studyhas aimed to analyze the main features of thepapers presented in the above-mentioned congressesin order to get a deeper knowledge of the researchcapacity of our professional group.Materials and methodology. A descriptive,observational and retrospective study. Sample: allthe papers. Dimension studied: structure andprocess. Time: 8 years. Data source: a collection ofthe papers presented in congresses. Development:collected variables: number of authors, type ofpaper, city and region, type of study, timing,nursing role, dimension analyzed, topic, hospital,department, type of statistics, relevance, financing,structural quality and others.Statistical processing: descriptive statistics forquantitative variables with means and standarddeviation (SD); qualitative variables are writtenin percentages. We have contrasted hypotheseswith X2 accepting ‘if p < 0.05’ as a statisticalsignificance.Results. Papers 736 (65-119), oral papers 270(40.4%), mean of authors 4.87 (1-16), SD 1.97; perprovinces: Barcelona 146 (19.8%); per autonomouscommunities: Catalonia 166 (22.6%); hospitals:University Hospital from Bellvitge 27 (4.2%);research studies 426 (65.3%); prospective studies333 (51%), quantitative 345 (53%); withdescriptive statistics 305 (46.9%); with a healthperception and health management pattern 76(10.3%); analyzed quality area: structure 379(51.5%); with the presence of an autonomous role380 (51.6%); most mentioned theme: respiratorycare 100 (13.6%), with relevance and/orapplicability 450 (69%); financed 23 (3.5%).Fulfillment of scientific structure: 97%.Conclusions. Intensive Nursing Care shows animportant amount of oral papers. Research studiesstand out among these papers, the former havinghigh structural quality and relevance and/orapplicability

[A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding]. / Estudio coste-efectividad sobre la medición del gradiente de presión venosa hepática en la profilaxis secundaria de la hemorragia digestiva varicosa.

OBJECTIVE: variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG) to guide secondary prophylaxis. METHODS: we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate. RESULTS: there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2. CONCLUSIONS: HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.

Bilateral inflammatory metachronic ERBB2 (HER2/neu)-positive breast carcinoma: prolonged survival with combined chemotherapy and trastuzumab

A patient with inflammatory breast carcinoma (IBC) diagnosed in the left breast responded to cisplatin and was treated with radical mastectomy and adjuvant therapy. Two years later C-erbB2-positive IBC was diagnosed in the right breast, and was treated with mastectomy and radiotherapy. Two years later skin metastases appeared, and trastuzumab was started initially as monotherapy, and later with paclitaxel and capecitabine. More than 12 years after diagnosis and 7 years after trastuzumab was started, the patient remains in complete clinical remission on trastuzumab and capecitabine (AU)

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Estudio coste-efectividad sobre la medición del gradiente de presión venosa hepática en la profilaxis secundaria de la hemorragia digestiva varicosa / No disponible

Objetivo: la hemorragia digestiva es una complicación frecuenteen pacientes con cirrosis hepática. La tasa de recidiva trasun primer episodio oscila en torno al 60%, motivo por el cual laprofilaxis está recomendada. Esta puede realizarse mediante fármacos(betabloqueantes y nitratos) combinados o no con ligaduraendoscópica con bandas. El objetivo de este estudio es valorar elcoste-efectividad de la medición del gradiente de presión venosahepática (GPVH) previo a la elección de la profilaxis secundaria.Métodos: creamos un árbol de decisión para calcular el costeefectividadde dos estrategias: grupo 1: pacientes a los que se les determinóel GPVH; cuando tras la administración de propranolol hubouna disminución del gradiente >= al 20% respecto al inicial o disminuyópor debajo de 12 mmHg, los pacientes fueron tratados con propranolol.Si no hubo tal variación del GPVH, se realizó ligadura endoscópicade las varices. Grupo 2: en este grupo no se monitorizó elGPVH. Los pacientes con varices grado I recibieron tratamiento conbetabloqueantes más nitratos y los que presentaban varices grandes(II, III, IV) fueron tratados con betabloqueantes y LEB.Resultados: en el grupo del estudio hemodinámico respondióun 36%, estos recibieron tratamiento betabloqueante, la tasa de resangradofue del 0%. En los no respondedores la tasa de resangradofue de un 17%. En el grupo sin estudio se trató con propranololmás nitratos al 28,42% y resangraron un 25%; la tasa de resangradoen el grupo que recibió tratamiento con betabloqueantes más ligaduraendoscópica fue de un 13%. El coste total en el grupo al quese realizó el estudio hemodinámico fue de 14.100,49 euros y de14.677,16 euros para el grupo sin estudio hemodinámico.Conclusiones: la realización del estudio hemodinámico es unaherramienta coste-efectiva en la profilaxis de la hemorragia digestivavaricosa en pacientes cirróticos y mantiene una relación costeefectiva favorable comparado con la no realización del mismo

Objective: variceal rebleeding is common following a firstepisode of hemorrhage in cirrhotic patients. The objective of thisstudy was to determine the cost-effectiveness of monitoring hepaticvenous pressure gradient (HVPG) to guide secondary prophylaxis.Methods: we created a Markov decision model to calculatecost-effectiveness for two strategies: Group 1: HVPG monitoringto decide treatment –when portal pressure was reduced by at least20 percent or HVPG was less than 12 mmHg after beta-blockeradministration, patients received beta-blockers; when portal pressuredid not meet these criteria therapy was endoscopic band ligation.Group 2: in this group there was no monitoring of HVPG.Patients with large varices received treatment with beta-blockerscombined with EBL; patients with small varices received betablockersplus isosorbide mononitrate.Results: there was no recurrent variceal bleeding in group 1for good responders, and for 17% of poor responders. In group 2a 25% rebleeding rate was detected in patients with small varicesand 13% for those with big varices. Overall cost in group 1 was14,100.49 euros, and 14,677.16 in group 2.Conclusions: HVPG measurement is cost-effective for thesecondary prophylaxis of variceal bleeding