Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones / Audit of cataract surgery in Cadiz: visual outcomes and complications

OBJETIVO: Dar a conocer los resultados y complicaciones de la cirugía de catarata senil en Cádiz. A falta de auditorías nacionales, comparamos nuestros resultados con la más reciente auditoría europea EUREQUO (2013) y con la auditoría británica RCOphth NOD (2015). MÉTODOS: Estudio longitudinal, prospectivo, antes-después de 312 pacientes intervenidos de cataratas en los Hospitales Universitarios Puerta del Mar y Puerto Real, en 2013-14. Variables recogidas: características sociodemográficas, agudeza visual (AV), síntomas secundarios a la catarata, comorbilidad ocular, tiempo de espera, preparación del cirujano (adjunto vs. residente), tasa y tipos de complicaciones quirúrgicas. RESULTADOS: La edad media de los pacientes fue de 73,92 ± 7,31 años. El 98,3% partieron de una AV ≥ 0,60 logMAR (≤ 0,25 decimal). La AV media preoperatoria fue de 1,01 logMAR (0,92-1,10), equivalente a 0,20 decimal (0,18-0,21). La tasa de complicaciones fue del 6,7%, con un 3,8% de roturas de cápsula posterior y un 2,8% de descompensaciones corneales. No se registraron casos de endoftalmitis. La AV media postoperatoria fue de 0,28 logMAR (0,22-0,33), equivalente a 0,67decimal (0,64-0,70). El 78,8% de los pacientes intervenidos adquirieron una AV ≤ 0,3 logMAR tras la cirugía (≥ 0,50 decimal), y el 27,6% una AV ≤ 0,0 logMAR (≥1,0decimal). CONCLUSIONES: Obtuvimos resultados inferiores a los del EUREQUO y a los del RCO phth NOD, donde se reporta una AV posquirúrgica ≤ 0,3 logMAR (≥ 0,50 decimal) en el 98 y en el 89% de los pacientes, respectivamente. Sin embargo, las poblaciones estudiadas son diferentes. Esperamos con nuestro estudio animar a otros hospitales públicos españoles a realizar auditorías y compartir resultados, como herramienta de autocrítica y mejora

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92 ± 7.31. Almost all (98.3%) of patients at consultation had a VA ≥ 0.60 logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28 logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤ 0.3 logMAR, and 27.6% of cases achieved a VA ≤ 0.0 logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3 logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives

Audit of cataract surgery in Cadiz: visual outcomes and complications. / Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones.

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92±7.31. Almost all (98.3%) of patients at consultation had a VA ≥0.60logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤0.3logMAR, and 27.6% of cases achieved a VA ≤0.0logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives.

The role of peritoneal dialysis in the treatment of ascites.

Cirrhosis represents a late stage of hepatic fibrosis and leads to high morbidity and mortality, and the most frequent complication is ascites. Only a few patients with advanced cirrhosis have 'refractory ascites' and do not respond to conventional treatment. Repeated paracentesis for evacuation is considered the treatment of choice in these cases. A large proportion of these patients have associated chronic kidney disease (CKD), which may require renal replacement therapy (RRT). Due to the complications associated with liver disease with coagulation disorders and tendencies towards spontaneous hypotension, there are significant problems associated to RRT, especially haemodialysis (HD). On the contrary, peritoneal dialysis (PD) offers several advantages over HD in cirrhotic patients (with or without ascites) thanks to better haemodynamic tolerance, as it is a continuous and slow technique. Furthermore, PD has a low rate of infection and bleeding.

Papel de la diálisis peritoneal en el tratamiento de la ascitis / The role of peritoneal dialysis in the treatment of ascites

La cirrosis representa un estadio avanzado de la fibrosis hepática y conlleva a una alta morbimortalidad cuya complicación más frecuente es la ascitis. Una minoría de pacientes con cirrosis avanzada tiene «ascitis refractaria» y no responden al tratamiento convencional. La paracentesis evacuadoras de repetición se consideran el tratamiento de elección en estos casos. Una gran parte de estos pacientes presentan asociada una enfermedad renal crónica (ERC), que puede precisar de tratamiento renal sustitutivo (TRS). Debido a las complicaciones asociadas a la enfermedad hepática de alteraciones de la coagulación y tendencia espontánea a la hipotensión arterial plantea problemas de cara al TRS, especialmente derivados de la hemodiálisis (HD). En este sentido la diálisis peritoneal (DP) ofrece varias ventajas respecto a la HD en pacientes con cirrosis, con o sin ascitis debido a su mejor tolerancia hemodinámica por ser un técnica continua y lenta, con baja tasa de complicaciones infecciosas y hemorrágicas (AU)

Cirrhosis represents a late stage of hepatic fibrosis and leads to high morbidity and mortality, and the most frequent complication is ascites. Only a few patients with advanced cirrhosis have 'refractory ascites' and do not respond to conventional treatment. Repeated paracentesis for evacuation is considered the treatment of choice in these cases. A large proportion of these patients have associated chronic kidney disease (CKD), which may require renal replacement therapy (RRT). Due to the complications associated with liver disease with coagulation disorders and tendencies towards spontaneous hypotension, there are significant problems associated to RRT, especially haemodialysis (HD). On the contrary, peritoneal dialysis (PD) offers several advantages over HD in cirrhotic patients (with or without ascites) thanks to better haemodynamic tolerance, as it is a continuous and slow technique. Furthermore, PD has a low rate of infection and bleeding (AU)

[Conservative treatment of post-traumatic periduodenal hematoma: presentation of a clinical case and review of the literature]. / Trattamento conservativo di ematoma periduodenale post-traumatico: presentazione di un caso clinico e revisione della letteratura.

The authors describe a case of post-traumatic hematoma of the duodenum in a two years old child. This is a very rare condition in paediatric age, but with the increasing incidence of traumatic pathology it can be predicted an increase of this condition. The duodenal hematoma can be treated either with surgical approach or with conservative treatment. The authors discuss the characteristics of the pathology, the etiopathogenetic mechanism, and propose the same classification adopted by some french authors. The type of lesion indicates the adequate therapy; in particular in the case report (type 1) a conservative treatment is adopted. The laboratory parametres are significative but none is diagnostic. In the present case the amylasemia is not elevated until two weeks after the trauma. Very important for diagnosis are T.C., roentgenography and echotomography, the last one can be easily used for the control of the resolution of the hematoma. The conservative treatment is based on nasogastric suction and parenteral nutrition; although the role of nonoperative treatment is emphasized, the importance of careful assessment for signs of peritonitis or enlarging tender mass cannot be overlooked.

[Sex change in children with Morris syndrome]. / Cambio de sexo en niños con síndrome de Morris.

Eleven boys with Morris syndrome underwent feminizing genitoplasty utilizing a segment of the sigmoid colon for neovaginal reconstruction. Bilateral orchiectomy was performed for cosmetic reasons and to prevent neoplasms. Patient follow-up ranging from 6 months to 13 years have demonstrated good results were obtained. No intra- or postoperative complications were observed. Patient psycho-social-sexual identification and satisfaction were achieved.

[New technic for the treatment of high intraabdominal cryptorchism: testicular autotransplantation with venous anastomosis only]. / Nueva técnica para el tratamiento de la criptorquidia intraabdominal alta: auto trasplante testicular con anastomosis únicamente venosa.

A new technique in the treatment of high intraabdominal cryptorchidism is proposed: testicular autotransplantation with venous anastomosis only. The technique consists in performing microsurgical anastomosis of the spermatic vein and homolateral inferior epigastric vein only for adequate venous drainage, leaving irrigation of testis to the deferential artery alone. We have utilized this technique in 16 cases and excellent results have been achieved. It has permitted performing surgery in younger patients (2 years). Surgical trauma and the duration of the operation are less compared to the Silber technique. There is a higher success rate and the procedure is easy to perform.

[Microsurgical spermatico-epigastric diversion in the treatment of varicocele in pre-adolescent patients]. / Derivación microquirúrgica espermaticoepigástrica en el tratamiento del varicocele en pacientes preadolescentes.

Varicocele is not an uncommon condition in pre-adolescence. Internal spermatic vein phlebography provides insight into vascular anatomy and etiopathogenesis. Eighty-six cases treated by microsurgical spermatico-epigastric anastomosis (Belgrano technique) are reported. This technique has been shown to achieve a very high cure rate (98.8%). Several techniques of venous anastomosis are described and compared with the Belgrano technique. The results show that the latter is the ideal technique because it not only resolves reflux but also provides adequate venous drainage to the testis.