Papel del cirujano general en el diagnóstico y tratamiento precoz del pie de Charcot / Role of the general surgeon in the early diagnosis and treatment of Charcot’ foot

INTRODUCCIÓN: El pie de Charcot (PC) consiste en un progresivo deterioro de los huesos y articulaciones, sobre todo en pacientes diabéticos afectos de neuropatía grave. El gran problema es que se puede confundir con otros procesos, retrasando el diagnóstico y tratamiento adecuados. El objetivo es analizar los casos de PC diagnosticados en nuestro hospital y, sobre todo, resaltar el papel del cirujano general. MATERIAL Y MÉTODOS: Estudio retrospectivo donde se registran los casos diagnosticados de PC entre la población diabética de nuestro Departamento de Salud y se hace una revisión de la literatura. RESULTADOS: Desde 2008 hasta 2012 se han diagnosticado 7 casos de PC (prevalencia de 1:710). Dos de los pacientes fueron diagnosticados erróneamente de celulitis. El tiempo medio de demora en el diagnóstico ha sido de 10 semanas (mínimo 1, máximo 24). El tratamiento inicial fue inmovilización de la extremidad. Una vez desapareció el edema, se colocó ortesis de descarga según el tipo anatómico de la clasificación de Sanders. La evolución ha sido favorable en 5 pacientes, un paciente precisó amputación transmetatarsiana y otro fue exitus por enfermedad cardíaca aguda. CONCLUSIONES: El PC es una enfermedad más frecuente de lo que creemos. El cirujano general es el pilar fundamental en el diagnóstico y tratamiento inicial. Ante la presencia de inflamación y edema del pie en un paciente con diabetes y neuropatía severa, una vez descartadas fundamentalmente la celulitis, la osteomielitis y la trombosis venosa profunda (TVP), se debe pensar en una neuroartropatía de Charcot

INTRODUCTION: The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. MATERIAL AND METHODS: Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. RESULTS: From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. CONCLUSIONS: The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered

Role of the General Surgeon in the Early Diagnosis and Treatment of Charcot Foot.

INTRODUCTION: The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. MATERIAL AND METHODS: Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. RESULTS: From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. CONCLUSIONS: The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered.

Cirugía endoscópica transanal con material convencional de laparoscopia, ¿es factible? / Transanal endoscopic surgery with conventional laparoscopy materials: is it feasible?

Introducción La cirugía endoscópica transanal con material convencional de laparoscopia puede ser una alternativa a la microcirugía endoscópica transanal (TEM) para la exéresis de lesiones rectales susceptibles de extirpación local. Material y método Analizamos prospectivamente 27 pacientes incluidos de forma consecutiva entre 1999 y 2009 a los que se les practicó una operación endoscópica transanal (TEO), mediante resección de pared total rectal. Todos los procedimientos se realizaron con un rectoscopio de 40mm inicialmente diseñado por nosotros y posteriormente con el rectoscopio de Storz, utilizando el equipo y el material convencional de laparoscopia. Resultados Hemos intervenido a 27 pacientes con una edad media de 69,4 años. 23 por lesiones benignas y 4 malignas. La distancia media del tumor a los márgenes anales ha sido de 8,2cm (rango 5-15) y el diámetro medio tumoral de 3,38±1,2cm. Se presentaron 4 complicaciones postoperatorias, 3 por sangrado y un caso de perforación. La estancia hospitalaria promedio fue de 6±3,75 días. No hubo mortalidad perioperatoria ni se han demostrado recidivas. Conclusión Es factible la realización de cirugía endoscópica transanal con material convencional de laparoscopia, con reducción de costes y accesible a cirujanos laparoscopistas (AU)

Introduction Transanal endoscopic surgery with conventional laparotomy materials may be an alternative to transanal endoscopic microsurgery (TEM) for the excision of rectal lesions susceptible to local resection. Material and method We prospectively analysed 27 patients included consecutively between 1999 and 2009, on whom a Transanal endoscopic operation (TEO) was performed by total resection of the rectal wall. All procedures were performed with a 40mm rectoscope, initially designed by us and later with the Storz rectoscope, using conventional laparoscopic tools and material. Results We operated on 27 patients with a mean age of 69.4 years: 23 due to benign lesions and 4 malignant. The medium distance of the tumour to the anal margins was 8.2cm (range 5-15) and a mean tumour diameter of 3.38±1.2cm. There were 4 postoperative complications, 3 due to bleeding and one case of perforation. The mean hospital stay was 6±3.75 days. There was no perioperative mortality or recurrences..Conclusion Performing transanal endoscopic surgery with conventional laparoscopy material is feasible, with a reduction in costs and accessible to laparoscopy surgeons (AU)

[Transanal endoscopic surgery with conventional laparoscopy materials: is it feasible?]. / Cirugía endoscópica transanal con material convencional de laparoscopia, ¿es factible?

INTRODUCTION: Transanal endoscopic surgery with conventional laparotomy materials may be an alternative to transanal endoscopic microsurgery (TEM) for the excision of rectal lesions susceptible to local resection. MATERIAL AND METHOD: We prospectively analysed 27 patients included consecutively between 1999 and 2009, on whom a Transanal endoscopic operation (TEO) was performed by total resection of the rectal wall. All procedures were performed with a 40mm rectoscope, initially designed by us and later with the Storz rectoscope, using conventional laparoscopic tools and material. RESULTS: We operated on 27 patients with a mean age of 69.4 years: 23 due to benign lesions and 4 malignant. The medium distance of the tumour to the anal margins was 8.2cm (range 5-15) and a mean tumour diameter of 3.38 ± 1.2cm. There were 4 postoperative complications, 3 due to bleeding and one case of perforation. The mean hospital stay was 6 ± 3.75 days. There was no perioperative mortality or recurrences.. CONCLUSION: Performing transanal endoscopic surgery with conventional laparoscopy material is feasible, with a reduction in costs and accessible to laparoscopy surgeons.