All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty: Technique and Results.

Objective The aim of the study is to describe the modified all-arthroscopic technique for triangular fibrocartilage complex (TFCC) ligamentoplasty in chronic injuries of the TFCC with distal radioulnar joint (DRUJ) instability, and to present the results obtained. Methods A prospective study was conducted including 11 consecutive patients with chronic TFCC injury with DRUJ instability who underwent an all-arthroscopic TFCC ligamentoplasty. During follow-up, the range of joint motion, grip strength, pain according to the visual analog scale (VAS), functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were measured, and any complications and necessary reinterventions were recorded Results We analyzed 11 patients with distal radioulnar ligament injury treated using the all-arthroscopic ligamentoplasty technique. Mean follow-up was 31.5 ± 4.4 (range 12-58) months. The technique presented achieved DRUJ stability in 100% of cases at 12 months. Grip strength and pain, showed a statistically significant improvement between the preoperative score and the two postoperative assessments. Functional assessment using the QuickDASH score and the MWS also improved significantly. Conclusion The all-arthroscopic technique for the reconstruction of irreparable peripheral TFCC tears is a reliable technique, intended not only to minimize the surgical trauma to reduce postoperative pain and to facilitate rehabilitation, but also to improve both the quality of the reconstruction and the functional outcome.

Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results.

Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure.

OBJECTIVES: To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007-2016). METHODS: The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries. RESULTS: Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period. CONCLUSIONS: The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.

Estudio de coste-beneficio comparando la reparación de la hernia ventral abierta y laparoscópica / Cost-benefit analysis comparing laparoscopic and open ventral hernia repair

OBJETIVO: La laparoscopia ofrece importantes ventajas clínicas respecto a la técnica abierta en la reparación de las hernias de pared abdominal. Se realiza un estudio coste-beneficio con el objetivo de analizar los resultados clínicos y los costes económicos comparando la técnica abierta y la laparoscopia en la reparación de la hernia de pared anterior abdominal y así determinar el procedimiento más eficiente. MATERIAL Y MÉTODOS: Estudio prospectivo de cohortes sobre 140 pacientes consecutivos con hernias ventrales, con el objetivo de evaluar el coste de ambas técnicas. Se analizan datos clínicos, morbilidad, estancia hospitalaria, complicaciones y costes. RESULTADOS: La vía laparoscópica presentó menor estancia media (p < 0,001), menor morbilidad postoperatoria y complicaciones (p < 0,001) y reducción en la tasa de reingresos. El coste del material laparoscópico fue más alto, aunque el coste total del procedimiento por paciente fue menor (2.865 Euros) vs. reparación abierta (4.125 Euros). CONCLUSIONES: La reparación laparoscópica de las hernias ventrales de pared abdominal aporta beneficios para los pacientes y presenta, además, un coste final del procedimiento sensiblemente menor, evitándose un gasto de 1.260 Euros por cada paciente intervenido por esta vía. Además de ser una técnica eficiente, la reparación laparoscópica es coste-efectiva

OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P < .001) and patient morbidity (P < .001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260 Euros per patient (2,865 Euros vs. 4,125 Euros). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260 Euros for each patient, and so this procedure should be considered a cost-effective approach

Cost-benefit analysis comparing laparoscopic and open ventral hernia repair.

OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260€ per patient (2,865€ vs. 4,125€). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260€ for each patient, and so this procedure should be considered a cost-effective approach.

Stoppa procedure in bilateral inguinal hernia.

The Stoppa procedure is a very safe repair of bilateral inguinal hernia, but it requires a learning period to achieve optimal results. We present a study with our experience and learning curve for this technique. Two hundred and ten patients with bilateral inguinal hernia (420 hernias) were repaired with Stoppa procedure from January 1995 to December 2003 with an average age of 57.2 years (range 28-89 years), with 8 women and 202 men (96%). Emergency surgery was performed for incarcerated hernia in six cases (2.8%). The rates of recurrent hernias, concomitant disease and associated surgical techniques were similar in all the years. Operative time decreased from 100 min (1995) to 61-66 min (2001-2003). Drain remained in place in 100% (1995), and 0% (2003). Regional anaesthesia was performed in 25% (1995) and 80-90% in the last years; hospital stay decreased from 5.1 to 1.2 days (2003), and morbidity from 50% (1995) to 12-16% (P<0.0001). There were three recurrences, two in the first 30 cases (6.6%), and one in the remaining 180 (0.5%) (4-92 months follow-up). The procedure was introduced in 1995 by one surgeon, performing 100% of cases, being accepted progressively by other surgeons. The first 25-30 cases of a surgical technique are the learning curve, with the highest rate of morbidity, time, technical and operative difficulties, and long hospital stay. As a result of the first surgeon's experience, some modifications of the technique are developed and results improved.

Emergencia hipertensiva durante la cirugía de un carcinoma renal asociado a feocromocitoma no diagnosticado / Hypertensive emergency during surgery of a renal carcinoma associated with an undiagnosed pheochromocytoma

OBJETIVO: Presentar un caso inusual de asociación de carcinoma renal y feocromocitoma ipsilateral no diagnosticado, que ocasionó severas alteraciones cardiovasculares durante su cirugía y que alerta a profundizar en el estudio de éstos nódulos suprarrenales antes de su exéresis aunque presenten una clínica anodina. MÉTODO: Varón de 61 años con H.T.A leve y controlada durante 40 años con tratamiento farmacológico, diagnosticado de Hipernefroma renal derecho y probable adenoma suprarrenal por UIV, Ecografía abdominal, TAC, Gammagrafía ósea y Arteriografía renal, con preoperatorio en límites normales. El paciente desarrolló una severa crisis hipertensiva intraoperatoria, controlada con Lidocaina, Nitroglicerina, Nitroprusiato sódico y Labetalol, interrumpiendose temporalmente la intervención hasta que una vez estabilizado, se prosiguió hasta completarla. RESULTADO: Anatomía patológica de Adenocarcinoma renal de células claras y Feocromocitoma.Estudio postoperatorio que incluye Dopamina, Adrenalina, Noradrenalina y Acido vanilmandélico normales. Rastreo con 131 MIBG normal. CONCLUSIONES: Ante la presencia de una masa suprarrenal aún con clínica irrelevante, se debe efectuar su estudio exhaustivo para descartar que se trate de un tumor funcionante, evitando así riesgos sumamente graves durante la cirugía (AU)