Tratamiento del divertículo de Zenker: comparación de diferentes técnicas / Treatment of Zenker’s diverticulum: Comparison of different techniques

Introducción y objetivos: Los divertículos de Zenker se han abordado quirúrgicamente con diferentes técnicas a lo largo de los últimos años, evolucionando desde la vía abierta hasta la endoscópica. En la cirugía endoscópica, se puede utilizar el láser CO2 o la grapadora. Se analizó la recidiva o persistencia del divertículo tras el tipo de cirugía realizado. Método: Es un estudio descriptivo retrospectivo de 22 pacientes tratados de divertículo de Zenker en el servicio de otorrinolaringología de nuestro hospital entre los años 2001 y 2011. Resultados: Se realizó tratamiento con cirugía endoscópica mediante láser CO2 en 13 pacientes, mediante grapadora en 6 pacientes, y en 3 pacientes se realizó abordaje abierto. El tiempo operatorio, de ingesta oral y de ingreso fueron menores en la cirugía con grapadora (52 min, 3 días, 5 días), que en la técnica con láser (58 min, 5 días, 8 días) y mayores en el abordaje abierto (107 min, 8 días, 11 días). El 68% de nuestros pacientes mejoró con la primera intervención, porcentaje que ascendió al 95%, teniendo en cuenta la segunda intervención en los pacientes que recidivaron tras la primera cirugía. Las complicaciones aparecieron en el 13,6% de los pacientes. Conclusiones: El tratamiento de elección en la actualidad del divertículo de Zenker es la cirugía por vía endoscópica. El abordaje endoscópico con grapadora parece presentar menos morbilidad y un tiempo de hospitalización más corto en comparación con el láser CO2 (AU)

Introduction and objectives: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO2 laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. Method: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. Results: Endoscopic surgery using laser CO2 was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. Conclusions: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO2 laser (AU)

[Treatment of Zenker's diverticulum: comparison of different techniques]. / Tratamiento del divertículo de Zenker: comparación de diferentes técnicas.

INTRODUCTION AND OBJECTIVES: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO(2) laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. METHOD: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. RESULTS: Endoscopic surgery using laser CO(2) was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. CONCLUSIONS: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO(2) laser.

Detecting psychogeriatric problems in primary care: factors related to psychiatric symptoms in older community patients.

Objective The aim was to determine the relationship and influence of different variables on the psychiatric symptomatology of older people who reside in the community, as detected by family practitioners.Design A cross-sectional and multi-centre study.Setting Twenty-eight general practices and two psychiatric practices in Huesca, Spain, from 19 primary care health centres.Subjects A sample of 324 patients aged over 65 years, representative of the older people who reside in the community in the province of Huesca.Main outcome measures Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured by family practitioner and were detected following specific questions from the Geriatric Mental State (GMS-B) examination, following DSM-IV criteria, being defined as 'concern and fear of suffering, or the idea of having a serious disease based on the interpretation of somatic symptoms'. Sociodemographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in three phases: univariate, bivariate and multivariate with logistic regression.Results At the time of the study, 46.1% of the older people studied suffered from some psychiatric symptom; 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (prevalence ration (PR) 3.3) and anxiety (PR 3.9). Age was a factor associated with cognitive impairment (PR 4.4). Depression was significantly related to severity of the physical illness (PR 61.7 in extremely severe impairment). Isolation (PR 16.3) and being single (PR 13.4) were factors which were strongly associated with anxiety; living in a nursing home was associated with psychotic symptoms (PR 7.6).Conclusions Severity of physical illness, isolation, living in a nursing home and female gender, among others, are related to psychiatric symptoms in community-residing older people identified in primary healthcare centres.

Rapid detection of herpes simplex virus DNA in genital ulcers by real-time PCR using SYBR green I dye as the detection signal.

We have evaluated a real-time PCR procedure based on the LightCycler technology for rapid detection of herpes simplex virus (HSV) in genital lesions. Two sets of primers, corresponding to the thymidine kinase and DNA polymerase regions, were used for the amplification reactions in separate capillaries containing the SYBR Green I dye as detection signal. In 28 of 118 samples (24%), HSV was isolated by conventional cell culture. All cell culture-positive samples were also positive by real-time PCR. Six additional cell culture-negative samples were positive by PCR with both sets of primers. Total processing time was less than 3 h. Real-time PCR using SYBR Green I as detection signal is a sensitive procedure for the rapid diagnosis of HSV in genital lesions.