Agreement and differences between the equations for estimating muscle and bone mass using the anthropometric method in recreational strength trainees.

Introduction: The interest in estimating muscle mass (MM) and bone mass (BM) has grown in the sporting arena, and more specifically in recreational strength trainees, leading to the creation of different strategies to assess them. The aims were: 1) to investigate the agreement between different MM and BM formulas, and the muscle-bone index (MBI), and to establish the differences between them, in a healthy young adult population; and 2) to analyze if there are differences between males and females in the comparison of MM, BM and MBI formulas. Methods: This study followed a descriptive cross-sectional design. A total of 130 adult active recreational strength trainees were evaluated according to the procedures described by the International Society for the Advancement in Kinanthropometry (ISAK). Estimations were made in kilograms of MM and BM by following the equations by different authors. Results: The results showed significant differences between the values obtained by all the MM and BM formulas in the general sample (p < 0.001), and by the majority of formulas for male and female samples. In the general sample, Lin's coefficient indicated a strong agreement between Kerr, Lee, and Poortmans' MM estimation equations (concordance correlation coefficient (CCC) = 0.96-0.97). However, when stratifying by sex, this agreement persisted only in males (CCC = 0.90-0.94), in contrast with a lack of agreement observed in females (CCC < 0.90). Discrepancies in bone mass agreement were noted both in the general sample (CCC < 0.15) and when stratified by sex (CCC < 0.12). Conclusions: In general, differences were found between the values reported by the MM and BM formulas in recreational strength trainees, without an agreement between them. Sex was shown to significantly influence the differences found. The practical implications are that when comparing an individual with reference tables, other studies, or if analyzing an individual's evolution, the same estimation equation should be used, as they are not interchangeable.

Validity and agreement between dual-energy X-ray absorptiometry, anthropometry and bioelectrical impedance in the estimation of fat mass in young adults.

Introduction: Assessment of fat mass has historically employed various methods like Dual-energy X-ray Absorptiometry (DXA), and bioelectrical impedance (BIA), and anthropometry with its set of formulas. However, doubts persist regarding their validity and interchangeability to evaluate fat mass. This research aimed to determine the validity of anthropometry, and BIA in estimating fat mass Vs DXA, considering the influence of sex and hydration status. Methods: A descriptive, cross-sectional study included 265 young adults (161 males and 104 females), assessed through DXA, BIA in a standing position, and anthropometry. A fat mass estimation formula with DXA, a fat mass estimation formula with BIA and 10 fat mass estimation formulas with anthropometry were calculated. Results: Significant differences were found across DXA, BIA and anthropometry in both kilograms and percentages for the overall sample (p<0.001), and when the covariable sex was included (p<0.001), with no significant effect of hydration status (p=0.332-0.527). Bonferroni-adjusted analyses revealed significant differences from DXA with anthropometry and BIA in most cases for the overall sample (p<0.001), as well as when stratified by sex (p<0.001-0.016). Lin's coefficient indicated poor agreement between most of the formulas and methods both in percentage and kilograms of fat mass (CCC=0.135-0.892). In the Bland-Altman analysis, using the DXA fat mass values as a reference, lack of agreement was found in the general sample (p<0.001-0.007), except for Carter's formula in kilograms (p=0.136) and percentage (p=0.929) and Forsyth for percentage (p=0.365). When separating the sample by sex, lack of agreement was found in males for all methods when compared with both percentage and kilograms calculated by DXA (p<0.001). In the female sample, all methods and formulas showed lack of agreement (p<0.001-0.020), except for Evans's in percentage (p=0.058). Conclusion: The formulas for fat mass assessment with anthropometry and BIA may not be valid with respect to the values reported with DXA, with the exception of Carter's anthropometry formula for general sample and Evans's anthropometry formula for female sample. BIA could also be an alternative if what is needed is to assess fat mass in women as a group.

Innovación en técnica quirúrgica: Dos técnicas no convencionales para el tratamiento de la coledocolitiasis / Innovative surgical techniques. Two non-conventional techniques for the treatment of choledocholithiasis

RESUMEN La litiasis vesicular asociada a coledocolitiasis puede tener distintos tratamientos, endoscópicos o quirúrgicos, dependiendo del paciente, el entrenamiento del personal médico y de la disponibilidad de instrumental. Ninguno ha demostrado estar exento de complicaciones. Presentamos dos técnicas tendientes a mejorar los resultados del tratamiento quirúrgico de la coledocolitiasis. Una es la extracción transcística de coledocolitiasis y stent, en pacientes que fueron tratados endoscópicamente por colangitis, tendiente a resolver el problema (la litiasis vesicular, la coledocolitiasis y el stent) en un solo tiempo por cirugía laparoscópica. La segunda es una nueva indicación de una técnica ya descripta, la dilatación papilar anterógrada con balón, utilizada en este caso para disminuir las fugas biliares tras un cierre primario de colédoco.

ABSTRACT Cholelithiasis associated with choledocholithiasis may have different treatments, either by endoscopy or surgery, depending on the patient, level of training of the medical staff and availability of instruments. None of them is free of complications. We report two non-conventional techniques aimed at improving the results of the management of choledocholithiasis. Transcystic removal of common bile duct stones and stent in patients who underwent endoscopic treatment for cholangitis is one of these new techniques to manage cholelithiasis, choledocholithiasis and stent removal in a single procedure through laparoscopy. The second technique is a new indication of a previously described procedure, antegrade balloon papillary dilation to reduce biliary leaks after primary closure of the common bile duct.

Litiasis coledociana de difícil resolución / Difficult common bile duct stones

RESUMEN Antecedentes: el manejo laparoscópico en un tiempo de la coledocolitiasis se acompaña de una tasa de éxito elevada en la mayoría de los casos. Una excepción a esto son los cálculos coledocianos difi cultosos. Objetivo: describir los resultados del manejo de cálculos coledocianos dificultosos. Material y métodos: revisión retrospectiva de una serie consecutiva de casos de cálculos coledocianos dificultosos tratados durante el período 2018-2020. Resultados: 8 pacientes cumplieron con el criterio de inclusión. El manejo en un tiempo por videola paroscopia (5 casos) tuvo un 60% de conversión a cirugía abierta. Los otros pacientes (3 casos) fueron manejados inicialmente con endoscopia biliar por colangitis grave y fueron resueltos luego en forma electiva por instrumentación transcística. Conclusión: esta experiencia inicial sugiere que el abordaje en dos tiempos podría favorecer la resolu ción mininvasiva de los cálculos coledocianos dificultosos.

ABSTRACT Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive approach.

Abordaje laparoscópico sistemático de la coledocolitiasis / Routine laparoscopic management of common bile duct stones

RESUMEN Antecedentes: la prevalencia conjunta de litiasis vesicular y coledociana aumenta con la edad y llega al 15% en la octava década de la vida. Su manejo continúa siendo controvertido: algunos profesionales prefieren el abordaje en un tiempo por videolaparoscopia, y otros, el abordaje en dos tiempos con endoscopia (CPRE preoperatoria) seguida de colecistectomía laparoscópica. Objetivo: evaluar la eficacia y seguridad del manejo en un tiempo por videolaparoscopia en pacientes consecutivos con diagnóstico de litiasis vesicular y coledociana. Material y métodos: estudio retrospectivo con datos de una base de datos prospectiva, entre julio de 2008 y julio de 2018. Resultados: sobre un total de 2447 colecistectomías laparoscópicas realizadas en el citado período, 416 (17%) presentaron litiasis coledociana. El éxito global de la vía transcística en la extracción de litiasis coledociana fue del 81,2%: del 70,4% en los casos con diagnóstico prequirúrgico de colestasis extrahepática litiásica y del 92,9% en los otros diagnósticos. La morbilidad fue del 4%, sin mortalidad ni lesiones quirúrgicas de la vía biliar. Conclusión : el manejo en un tiempo por videolaparoscopia es eficaz y seguro debido al elevado éxito global de la instrumentación transcística (ITC). El diagnóstico preoperatorio de coledocolitiasis condi ciona una disminución de esa eficacia, por mayor indicación de coledocotomía, con un aumento de la morbilidad y del tiempo de internación.

ABSTRACT Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.

Diez estrategias para mejorar la eficacia de la cirugía biliar laparoscópica / Ten strategies to improve the efficacy of laparoscopic biliary surgery

El abordaje laparoscópico es el método de elección para el tratamiento de la litiasis vesicular sintomática, y para muchos también lo es para la coledocolitiasis. Algunas situaciones especiales e infrecuentes en el tamaño, número y ubicación de los cálculos o en alteraciones de la anatomía biliar embriológicas o adquiridas pueden generar dificultades para la resolución de estas afecciones con técnicas laparoscópicas habituales. Para estas situaciones describimos 10 estrategias quirúrgicas de aplicación relativamente sencilla y que requieren de escasos recursos económicos, por lo que creemos que pueden adaptarse a la mayor parte de los centros quirúrgicos

Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers

Ten strategies to improve the efficacy of laparoscopic biliary surgery. / Diez estrategias para mejorar la eficacia de la cirugía biliar laparoscópica.

Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers.

Quiste de conducto cístico / Cystic duct cyst

Los quistes congénitos de la vía biliar son infrecuentes y se definen por la dilatación quística del árbol biliar en cualquiera de sus porciones. Los quistes del conducto cístico son aún menos frecuentes. Su etiología permanece incierta y el tratamiento consiste en la resección debido a su potencial desarrollo de malignidad. Presentamos el caso de una paciente en la que se diagnosticó dilatación del conducto cístico y fue tratada por vía laparoscópica.

Congenital biliary duct cysts are rare and are defined as cystic dilatations of the biliary tree in any of its portions. Cystic duct cysts are more uncommon. Their etiology remains uncertain and they should be resected due to the possible development of malignancy. We report the case of a female patient with a diagnosis of dilation of the cystic duct that was treated with laparoscopic surgery.

Schloffer's tumor: Case report and review of the literature.

INTRODUCTION: The so-called Schloffer tumor (ST) is a rare inflammatory pseudotumor. It usually appears several years after abdominal surgery or trauma. PRESENTATION OF CASE: A 32-year-old man was referred to our hospital complaining of a painful mass in the left hypochondrium, postprandial distension and a weight loss of about 14kg. He had had a left inguinal hernioplasty without mesh the previous year. Ultrasonography of the abdomen showed a 2cm×2cm hypoechoic lesion in contact with the abdominal wall. Computerized tomography of the abdomen showed a heterogeneous mass in the great omentum. Laparoscopic exploration revealed an omental mass firmly attached to the abdominal wall. A great deal of purulent fluid spread during the procedure. Due to the difficult exploration, the procedure converted to hand assisted laparoscopy. We find an omental tumor involving the stomach and the transverse colon. Inside the mass there were purulent material and non-absorbable sutures. A drain was left inside the cavity of the abscess. Histological examination showed chronic inflammation. DISCUSSION: ST characteristically presents a central chronic abscess containing non-absorbable sutures. It has been described after appendectomy, hernioplasty, hysterectomy, gastrectomy or colonic resections. Although benign, its progressive growth and infiltrating behavior resemble malignant tumors. CONCLUSION: We suggest that a mini-invasive approach should always be performed. The interesting thing about this case is the appearance of the tumor in a place far away from the previous surgical site. A simple drainage and removal of suture material solves the problem of these patients.