Short- and mid-term outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Our experience after 198 consecutive cases.

BACKGROUND: Robot-assisted total mesorectal excision is a safe alternative for rectal cancer treatment. Nevertheless, substantial data is still missing. Our aim was to assess the perioperative and oncological outcomes of the routine use of the robotic-assisted approach for rectal cancer treatment. PATIENTS AND METHODS: 198 Consecutive robotic rectal resections were performed between January 2011 and April 2015 in patients with stage I-IV disease. We prospectively evaluated peri and postoperative data, pathological findings and mid-term oncological outcomes. RESULTS: 36 Abdominoperineal Amputations, 28 High Anterior Resections, 131 Low Anterior Resections and 3 Hartmann operations were performed. Mean age, ASA, BMI and distance form anal verge were respectively 67.5 years, ASA II, 26.95 kg/m(2) and 5.9 cm. 71.2% Patients received neoadjuvant therapy. Mean OR time was 294 minutes. Conversion occurred in 4.5%. Mean postoperative stay was 8 days. 36 Patients required blood transfusion with a mean of 162 ml. Complications Clavien III-IV were 12.1%. 8 complete responses were observed, 50 UICC class I, 84 class II, 51 class III and 13 class IV. Mean lymph node harvested were 11.7. Mean distal margin was 3.3 cm. 11 Circumferential margins were affected in UICC class III-IV patients. Postoperative mortality was 0.5%. Local recurrence was observed in 5% patients. Median follow-up was 27.6 months. LIMITATIONS: Single institution descriptive study. CONCLUSIONS: The routine use of robotic assisted laparoscopic surgery may help to achieve lower conversion rates with lower ventral hernia rates and similar oncological outcomes using a minimally invasive approach in a non-selected group of patients with non-selected rectal tumours.

Preclinical cadaveric study of transanal robotic proctectomy with total mesorectal excision combined with laparoscopic assistance.

BACKGROUND: Anterior resection with total mesorectal excision (TME) is the standard method of rectal cancer resection. However, this procedure remains technically difficult. A robotic transanal approach could overcome some of these limitations. An initial laboratory experience with robotic transanal TME using a new designed port on human cadavers is reported. METHODS: The feasibility of robotic transanal TME and ideal set-up were evaluated in human cadavers. For the da Vinci Si HD system transanal access and total mesorectal excision, a specifically designed port was used. RESULTS: It was possible to complete a proctectomy with transanal total mesorectal excision. The port proved to be very reliable and facilitated docking of the robotic arms. CONCLUSION: Using the robotic technology and a specifically designed port for robotic transanal access, TME was shown to be feasible and one specific preferred set-up was determined. Further clinical trials will be necessary to assess the safety and efficacy of this technique.

Estado comatoso tras ingesta de cannabis / Comatose state after cannabis intake

No disponible

Traumatismo esplénico en un niño / Splenic traumatims in a child

No disponible

Control de calidad en la cirugía mayor ambulatoria de la hernia inguino-crural / No disponible

INTRODUCCIÓN: Uno de los principales objetivos de toda unidad de C.M.A. debe ser su control de calidad y estos controles deben ser al menos los que se enumeran en la guía de A.S.E.C.M.A de 1999.OBJETIVO: Uno de los principales objetivos de toda unidad de C.M.A. debe ser su control de calidad y estos controles deben ser al menos los que se enumeran en la guía de A.S.E.C.M.A de1999.RESULTADOS: Durante el período enero1997 y diciembre del 2001 han sido intervenido quirúrgicamente de hernia inguinal y de forma ambulatoria, 358 pacientes a los que se practicaron362 intervenciones. Los criterios de calidad y efectividad examinados, fueron : estancias inesperadas de 0,23 días, sufrieron complicaciones menores en la unidad de CMA el 7,18% de los pacientes y en su domicilio el 2,2%, el número de (..) (AU)

HISTORY: One of the first objectives of all Ambulatory Surgical Units must be the control of quality, and these controls should at least be those given in the ASECMA guide of 1999.OBJECTIVE: The control of quality for inguinal hernias in Ambulatory Surgery. RESULTS: Between January 1997 and December 2001 we reviewed our series of 362femoral and inguinal hernioplasties performed on358 patients on an ambulatory basis. The following quality criteria were evaluated: efficiency(unexpected hospital stay of 0.23 days), minor complications during stay in the Ambulatory Surgical Unit (7.18%) and at home after discharge(2.2%), number of re-operations (0%), number of patients unsuitable for discharge that required admission to hospital (12.9%), number of patients removed from the programme for surgery (4.2%).Other quality criteria evaluated were: accessibility(average waiting list time of 66.57 days (..) (AU)

Tumor de Krukenberg secundario a neoplasia gastrica / Krukenberg tumor secondary to gastric neoplasia

No disponible

Autoevaluación de un proceso asistencial (colecistectomía laparoscópica) / Self-evaluation of a health care process: laparoscopic cholecystectomy

Introducción. Presentamos una forma de evaluar la asistencia clínica, establecimiento de una "ruta crítica" de un proceso asistencial "trazador". Pacientes y método. Se han estudiado 423 pacientes colecistectomizados por vía laparoscópica en 69 meses, de los cuales el 16 por ciento presentaba litiasis coledocal y el 30 por ciento colecistitis agudas. Los datos fueron recogidos de la historia clínica, del servicio de codificación del hospital y del propio INSALUD, así como de las respuestas remitidas a una encuesta enviada después del alta al paciente. Resultados. La colecistectomía se pudo realizar por vía laparoscópica en el 90 por ciento de los pacientes, la colangiopancreatografía retrógrada endoscópica fue efectiva en el 90 por ciento de coledocolitiasis, con valor predictivo positivo del 62,2 por ciento, las tasas de morbilidad laparoscópica fueron del 10 por ciento, y mortalidad del 1,4 por ciento. El índice de reingresos fue del 4,7 por ciento, y la estancia global de 6,1 días. El tiempo en lista de espera de 50 días. El grupo de diagnóstico relacionado (GDR) (494) supuso un coste de 238.874 ptas. La baja laboral ha tenido una media de 54,62 días. El consentimiento informado constaba en la historia del 67,7 por ciento de los pacientes, el informe de alta médica en el 94,6 por ciento y el informe anatomopatológico en el 100 por ciento. La puntuación media de la satisfacción fue superior al 80 por ciento. Conclusiones. Debemos mejorar algunos aspectos de la recogida de datos del servicio de información. La calidad global asistencial es alta y estamos en disposición de iniciar la colecistectomía como cirugía mayor ambulatoria. Los costes directos hospitalarios se encuentran por debajo de la media de los hospitales de sus características, aunque no así los costes indirectos (invalidez laboral transitoria). La satisfacción del paciente es muy alta (AU)

[Continuous practice and advanced training in interventional cardiology. Recommendations for the assessment and maintenance of proficiency in interventional cardiology. A statement for physicians and advanced training units from the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology]. / Práctica continuada y enseñanza avanzada en cardiología intervencionista. Recomendaciones de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología para la capacitación y recapacitación de cardiólogos intervencionistas y unidades de formación.

This report reflects the interest of the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology in increasing quality, safety and applicability of percutaneous procedures, by giving scientific keys aimed at improving related functions of teaching or planning in this field and enhancing competence and prestige of Spanish interventional cardiologists. The purpose of the document is to describe the importance of current interventional cardiology, to identify quality references and to establish minimum acceptable requirements for assessing and maintaining the competence of practicing or providing advanced training in this discipline. To achieve this goal, a search for a gold standard of the different techniques of general interventional practice was carried out, and predictors of postprocedural outcome were analyzed, as well as their relation with different kinds of circumstances. This analysis identified coronary angioplasty as the standard on which recommendations regarding competence in overall interventional cardiology standards of quality and assessment and maintenance of proficiency must be based. On the other hand, the strong influence of experience and knowledge of results has been documented, especially in high-risk or high-complexity settings. On this basis, the report establishes specific recommendations about proficiency for practice and advanced training. It also suggests that interventional cardiology should be considered as a subspecialty, of cardiology requiring specific credentials.

[The determination in the blood of the enzyme neuron-specific enolase in children with acute encephalopathies: the prognostic value in neurological sequelae]. / Determinación en sangre de la enzima enolasa específica neuronal en niños con encefalopatías agudas: valor pronóstico de secuelas neurológicas.

OBJECTIVE: The objective of this study was to evaluate if there is a correlation between blood levels of the enzyme neuron-specific enolase in children with non-traumatic acute encephalopathies with severe alterations in consciousness and the neurological sequellae. PATIENTS AND METHODS: Neuron-specific enolase (EC 4.2.1.11) activity in plasma was measured by radioimmunoassay in 9 children aged 7 months to 5 years, who suffered acute encephalopathy and coma of non-traumatic origin. The etiology was acute viral encephalitis (n = 4), near drowning (n = 2), shock (n = 2) and cardiac arrest (n = 1). Blood samples were obtained between 24 and 72 hours after the onset of encephalopathy. The neurological status was evaluated 18 months after the onset of encephalopathy in the 8 surviving patients (1 patient with brain death criteria died in the acute stage). RESULTS: Enzyme activities were significantly higher in the children who showed neurological sequelae (median 68.9 ng/ml, range 35.0-95.6, n = 4) than in those who did not present neurological abnormalities (median 15.8 ng/ml, range 9.7-18.7, n = 5), with p < 0.05. No differences were found between the latter and the control group (median 7.7 ng/ml, range 4.1-12.7, n = 10). CONCLUSIONS: It appears that the presence of elevated neuron-specific enolase in blood is predictive of neurological outcome in children with acute encephalopathies of non-traumatic origin.

[Prognostic implications of early discharge from the coronary unit in patients with acute myocardial infarction]. / Implicaciones pronósticas del alta precoz de la unidad coronaria en pacientes con infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: The high demand for health care has obliged Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objective have been: a) to analyse the characteristics and the evolution (death or readmission) during the first month of patients with myocardial infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group patients for complications who could be discharged early from the Coronary Unit. PATIENTS AND METHODS: A study of 978 consecutive patients who had been admitted for acute myocardial, in faration were divided into two groups according to their length of stay in the Coronary Unit (A < or = 2 and B > 2 days). Their baseline characteristics, course of stay and vital status at month, were compared. A subgroup of patients at low risk was studied and complications that might have arisen from their early discharge from the Coronary Unit were assessed. RESULTS: Seventy-three patients (7.5%) died within the first two days. Of the remaining 905, the stay was 2 days or less for 336 patients (group A); and longer than 2 days for 569 (group B). Group A had a higher frequency of dyslipemia, Killip class I on admission, uncomplicated myocardial infarction in the Coronary Unit and the use of beta-blockers and had less frequency of diabetes, Q wave myocardial infarction, anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 18 patients from group B died, the rate of death or readmission into the Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip class on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary unit. A subset of 378 low risk patients (Killip I on admission, uncomplicated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgroup, those patients whose stay was equal to or less than two days were more frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034). CONCLUSION: Selected patients with myocardial infarction can be discharged very early from the Coronary Unit with a low risk of death. A readmission rate following discharge of some 5% must be allowed for these patients.

[Role of noninvasive examinations in the management of ischemic heart disease. III. Assessment of myocardial viability]. / Papel de las exloraciones no invasivas en el manejo de la cardiopatía isquémica. III. Estimación de la viabilidad miocárdica.

Assessment of myocardial viability is a field of growing interest. This article summarizes the pathophysiology of myocardial stunning and hibernation; both phenomena are associated with the presence of dysfunctional, viable myocardium. The techniques that are currently available for the assessment of viability, and the clinical situations in which these assessments may be more useful are discussed.

[Post-implant antithrombotic treatment after intracoronary stents. Thrombotic occlusion]. / Tratamiento antitrombótico postimplante intracoronario de stent. Oclusión trombótica.

The stent has been demonstrated to be a useful device in the treatment of complicated coronary angioplasty and in the prevention of restenosis. However, its efficacy was seen to be initially limited due to a high incidence of thrombotic occlusion of the stent in the first month after implantation and a high rate of hemorrhagic complications when a severe antithrombotic treatment with antiplatelet drugs (aspirin and dypiridomole) was associated with anticoagulation therapy with intravenous sodium heparin and dicumarol. Both phenomena increased morbidity and the post-implantation costs of stenting. The development of new strategies in stent implantation and post-implantation management have significantly reduce these complications. The objective of this study is to review the physiopathology of thrombotic occlusion following intracoronary stent implantation and the efficacy of various antithrombotic pharmacological strategies being used for its prevention. Although certain factors existing prior to implantation (thrombus, severe dissection, and the size of the vessel) augment the probability of occlusion in the stent, the result of the implantations is a good predictor of the development of this complication. Recent studies have shown that when optimal coronary stent implantation (high pressure, strict angiographic or ultrasound criteria) resulting in a minimal or absent residual stenosis and adequate apposition of the stent against the arterial wall is associated with new antithrombotic strategies, the rate of thrombotic occlusion should be less than 1.5% and the rate or hemorrhagic complications should not be greater than what has been described for conventional angioplasty. The most consolidated current antithrombotic therapy is the association of aspirin and ticlopodine which has demonstrated its efficacy in both observational and randomized studies. The combination of antiplatelet drugs and low molecular weight heparin has also demonstrated its efficacy in non-randomized studies and may constitute an alternative in some clinical or angiographic situations. The development of stents with a smaller thrombogenic surface contact with blood (made of materials which are not thrombogenic or are coated) hopefully provides another possibility for the near future. All of these advances have minimized the problem of thrombotic occlusion of the stent and have contributed to the great expansion in the use of this technique in current interventional cardiology.

[Disease of the left coronary trunk. Our experience. An analysis of surgical morbimortality]. / Enfermedad del tronco de la coronaria izquierda. Nuestra experiencia. Análisis de la morbimortalidad operatoria.

INTRODUCTION AND OBJECTIVES: The superiority of surgical treatment over other procedures in the left main coronary artery stenosis is well known, being today the therapy of choice. The purpose of this work is to analyze the clinical characteristics and the immediate results of surgery in our patients. PATIENTS AND METHODS: In this paper we under-took a retrospective study of 147 consecutive patients, 129 men and 18 women with a 50% or more left main coronary artery stenosis without associated valvular disease, operated on at our institution during a period of 3.5 years, between January 1992 and May 1995. Thirty-one variables were analyzed under Chi-square, comparison of proportions and Student's t-tests. Then, it has been developed into a multivariant logistic regression of significant variables (p less than 0.05) of factors influencing mortality and rhythm disturbances which have been the most frequent postoperative complication. RESULTS: The mean age was 65 years. Sixty-two per cent had unstable angina and 51.7% had previous myocardial infarction. An average of 3.1 grafts were performed. Total mortality was 6.8%. The complications were 17% arrhythmias, 8% low cardiac output and 6% perioperative myocardial infarction. In the multivariate analysis, mortality has been strongly related to the presence of perioperative myocardial infarction and also with moderate to severe cardiomegaly and a high left ventricular end-diastolic pressure. Arrhythmias were related to an advanced age. CONCLUSIONS: 1) In hospital mortality remains within acceptable limits and is influenced by the presence of perioperative myocardial infarction, cardiomegaly and a high left ventricular end-diastolic pressure, and 2) elderly patients have more damaged vessels, more diseased coronary segments, and more complications, especially rhythm disturbances.