Tratamiento de la hernia inguinal bilateral con malla autoadhesiva en régimen de cirugía ambulatoria. ¿Un nuevo estándar? / Bilateral inguinal hernia repair with self-gripping mess in Day Surgery setting: a new standard?

Introducción: El empleo de mallas confeccionadas con materiales parcialmente reabsorbibles y un diseño que permite que se fijen al tejido sin suturas se plantea como estándar terapéutico en la hernioplastia inguinal bilateral, disminuyendo los tiempos quirúrgicos y mejorando el dolor y la recuperación postoperatoria y, por tanto, favoreciendo la ambulatorización del proceso. Material y métodos: Estudio retrospectivo a través de la historia clínica electrónica (IANUS) de 58 pacientes intervenidos en nuestro servicio en el periodo comprendido entre enero de 2011 y marzo de 2013. Resultados: Se han intervenido en la unidad de cirugía mayor ambulatoria (UCMA) 34 pacientes (58,6 %) y 24 (41,4 %) en régimen de cirugía de tarde. De los pacientes intervenidos en UCMA, solo 3 (8,8 %) precisaron ingreso. De los operados de tarde, 14 (58 %) tuvieron más de una pernocta. Sufrieron dolor agudo intenso 8 pacientes, 4 intervenidos en programa de cirugía ambulatoria y 4 en cirugía de tarde. Presentaron hematomas postoperatorios 8 pacientes, la mayoría intervenidos en cirugía de tarde, estado físico ASA III y tratados con antiagregantes o anticoagulantes. Conclusiones: La hernioplastia inguinal bilateral con malla autoadhesiva en UCMA es un procedimiento ambulatorizable casi al 100 %. Puede plantearse como nuevo estándar en el tratamiento ambulatorio de las hernias inguinales bilaterales (AU)

Introduction: The use of meshes made with partially absorbable materials and a design that allows the tissue to be fixed without sutures, is considered as a therapeutic standard in the bilateral inguinal hernia repair, decreasing surgery time and improving the pain and the postoperative recovery, and for that, helping the ambulatorization of the process. Material and methods: A retrospective study using the electronic medical record (IANUS) of 58 patients operated in our Service in the period between January 2011 and March 2013. Results: The patients are males in 95 % of the cases. 58.6 % underwent surgery in our outpatient surgery unit, 8.8 % needed to be admitted to hospital 41.4 % were operated in the regime of evening surgery, having to sleep overnight 58 %. 8 patients suffered severe acute pain, 4 were operated in ambulatory surgery and 4 in evening surgery. 8 patients had postoperative haematomas, the majority had been operated the evening before, were ASA III and treated with antiplatelet drugs or anticoagulants. Conclusion: The bilateral inguinal hernia repair with self-gripping mesh in our outpatient surgery unit is a day-case episode nearly 100 %. It can be considered as a new standard in the outpatient treatment of the bilateral inguinal hernias (AU)

Prevalence of mutations in TSHR, GNAS, PRKAR1A and RAS genes in a large series of toxic thyroid adenomas from Galicia, an iodine-deficient area in NW Spain.

OBJECTIVE: Toxic thyroid adenoma (TA) is a common cause of hyperthyroidism. Mutations in the TSH receptor (TSHR) gene, and less frequently in the adenylate cyclase-stimulating G alpha protein (GNAS) gene, are well established causes of TA in Europe. However, genetic causes of TA remain unknown in a small percentage of cases. We report the first study to investigate mutations in TSHR, GNAS, protein kinase, cAMP-dependent, regulatory, type I alpha (PRKAR1A) and RAS genes, in a large series of TA from Galicia, an iodine-deficient region in NW Spain. DESIGN AND METHODS: Eighty-five TA samples were obtained surgically from 77 hyperthyroid patients, operated on for treatment of non-autoimmune toxic nodular goitre. After DNA extraction, all coding exons of TSHR, GNAS and PRKAR1A genes, and exons 2 and 3 of HRAS, KRAS and NRAS were amplified by PCR and sequenced. Previously unreported mutants were cloned in expression vectors and their basal constitutive activities were determined by quantification of cAMP response element (CRE)-luciferase activity in CO7 cells transfected with wild-type and mutant plasmids. RESULTS: TSHR gene mutations were found in 52 (61.2%) samples, GNAS gene mutations in 4 (4.71%) samples and no PRKAR1A or RAS mutations were found. Only three previously unreported mutations were found, two affecting the TSHR, A623F and I635V, and one affecting the G-protein alpha-subunit (Gsalpha), L203P. All mutant proteins showed higher CRE-luciferase activity than their wild-type counterparts. CONCLUSIONS: TA in a hyperthyroid population living in Galicia, a Spanish iodine-deficient region, harbours elevated frequencies of TSHR and GNAS mutations activating the cAMP pathway. However, the genetic cause of TA was undetermined in 34% of the TA samples.

Breast tumor resembling the tall cell variant of papillary thyroid carcinoma: a case report.

The breast tumor resembling the tall cell variant of papillary thyroid carcinoma is a very unusual mammary carcinoma whose histologic and predominant nuclear features mimic a papillary thyroid carcinoma. We report the case of a 64-year-old woman who presented with a palpable nodule in the right breast. Fine needle aspiration disclosed abundant cellularity with isolated cells, sheets, and papillary formations of epithelial cells with nuclear grooves. Histologically, the neoplastic cells were arranged in a solid to papillary architecture, with follicular-like and cribriform areas. The cells were columnar to cuboidal with eosinophilic cytoplasm, clear chromatin, nuclear grooves, and occasional nuclear pseudoinclusions. Tumor cells were positive for cytokeratins, alpha and beta-estrogen receptors, progesterone receptor, androgen receptor, CEA, and bcl-2. We searched for BRAF mutations with negative results. Recognizing the cytologic and histologic characteristics of these peculiar mammary tumors that mimic thyroid carcinomas can avoid unnecessary clinical investigations.

[Digestive hemorrhage as the first symptom of a rupture of an abdominal aortic aneurysm]. / Hemorragia digestiva como primer síntoma de rotura de aneurisma de aorta abdominal.

Primary aortoduodenal fistula is an uncommon complication of abdominal aortic aneurysm and is a rare cause of gastrointestinal bleeding. A case of primary arterioenteric fistula due to the rupture of an abdominal aortic aneurysm into the third portion of the duodenum is presented. Aneurysmectomy, duodenal repair, and extra-anatomic revascularization of the legs was performed. Diagnosis of primary aortoenteric fistula is difficult. The usual explorations are not demonstrative, and exploratory laparotomy is often mandatory.

[Hepatic cystadenoma: report of a case]. / Cistoadenoma hepático: presentación de un caso.

A case is presented of bilobar hepatic cystadenoma. This is a rare benign tumor in which an adequate preoperative diagnosis is important for correct treatment. A review is made of the literature and controversial aspects of this infrequent lesion are discussed.