Use of artificial intelligence in the detection of the critical view of safety during laparoscopic cholecystectomy.

BACKGROUND: This study aimed to evaluate the use of artificial intelligence (AI) to detect the critical view of safety during elective laparoscopic cholecystectomy. METHODS: This was a prospective, observational study evaluating the detection of the critical view of safety with an AI software in a consecutive series of elective laparoscopic cholecystectomies compared with the blinded evaluation of 3 surgeons. The program was created using the digital tools PyCharm (JetBrains), Google Colab Pro (https://colab.google/), and YOLOv8 (Ultralytics). RESULTS: A total of 40 consecutive elective laparoscopic cholecystectomies were included in the study. The program was able to detect the critical view of safety in all cases following the experts' blinded opinion. CONCLUSION: In this preliminary experience, an AI software was able to detect the critical view of safety in elective laparoscopic cholecystectomies. Its application during nonelective cases, in which the critical view of safety is harder to achieve, might warrant further studies.

Integral Use of Red Wine Pomace after Hydrostatic High Pressure: Application of Two Consecutive Cycles of Treatment.

The influence of applying hydrostatic high pressure (HHP) to red grape pomace cv. Tempranillo was studied to obtain an ingredient rich in bioactive compounds for the manufacture of food products. Four treatments were investigated: (i) 600 MPa/1 s; (ii) 600 MPa/300 s, and other two treatments with 2 cycles of HHP: (iii) 2 cycles of 600 MPa/1 s; and (iv) 1 first cycle of 400 MPa/1 s and a second cycle 600 MPa/1 s. Treated pomace was stored at different temperatures (4 and 20 °C). The application of two consecutive cycles had no effect on the microorganisms' inactivation compared to only one cycle. Immediately after HHP, the phenolic compounds content was maintained. However, HHP had no influence on the polyphenol oxidase enzyme (PPO), and so the phenolic compounds were significantly reduced during storage. Hence, the shelf-life of red grape pomace was significantly reduced at both temperatures, although phenolic compounds were better preserved under refrigeration than at room temperature.

Application of White-Wine-Pomace-Derived Ingredients in Extending Storage Stability of Fresh Pork Burgers.

White wine pomace, a by-product from winemaking, was stabilized after the application of thermal blanching (with the aim of deactivating the polyphenoloxidase enzyme), milling, and processing by hydrostatic high-pressure treatment (with the aim of reducing initial microbial loads while preserving phenolic compounds content). The valorized pomace (VP) ingredient was added at different proportions to pork burgers (0.5%, 1%, and 3% w/w) to improve their preservation, and the effect was compared to those produced by sulfites and with a control (without sulfites or VP). Burgers were vacuum-packed and refrigerated for 7 days. Microbiological, color, oxidation, and sensory parameters were analyzed. Neither sulfites nor VP reduced the microbial development of most microorganism groups evaluated (p > 0.05); however, both prevented coliform growth during storage (p < 0.01). The use of sulfites prevented the discoloration of burgers during storage, while VP had no effect (p < 0.001). On the contrary, VP limited lipid and protein oxidation development during storage (p > 0.05), while sulfites had no effect. Therefore, the use of VP from white wine production could have an antioxidant effect but a limited antimicrobial or color-protective effect for the preservation of pork burgers.

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.

Retroperitonitis apendicular: factores asociados y manejo de una complicación seria

Antecedentes: La retroperitonitis es una rara y severa complicación de la apendicitis. Hasta el presente solo unos pocos reportes de casos han sido publicados en la literatura inglesa. Objetivo: El objetivo de este trabajo es analizar una serie consecutiva de 11 casos tratados en nuestra institución. Materiales y Método: Análisis retrospectivo de una base de datos recolectada en forma prospectiva de todos los pacientes admitidos por retroperitonitis de origen apendicular durante el período marzo 2017-septiembre 2020. Se analizarán las variables asociadas con esta complicación y su manejo. Resultados: 11 pacientes de un total de 601 con diagnóstico de apendicitis presentaron una retroperitonitis durante el período analizado (1,83%). El retardo en el diagnóstico fue en promedio de 8 días (rango 3 - 14 días). Todos los pacientes tuvieron un apéndice retrocecal y 81% presentaron un coprolito asociado. 45% fueron manejados inicialmente con abdomen abierto y contenido, y 55% con cierre fascial primario (50% de fracaso). La morbilidad y mortalidad fueron del 81% y 18%, respectivamente Discusión: La localización retrocecal del apéndice, la presencia de un coprolito y la presentación atípica, con demora en el diagnóstico, fueron factores comunes presentes en nuestra experiencia. El manejo con cierre fascial primario fracasó en la mitad de los casos. La morbimortalidad fue elevada. Conclusión: La retroperitonitis es una infrecuente pero severa complicación de la apendicitis, con elevada morbimortalidad.

Background: Retroperitonitis is a rare and life-threatening complication of appendicitis. So far, only a few cases have been described so far in the English literature. Aim: The objetive of this paper is to analyze a consecutive series of 11 patients treated at our institution. Materials and Method: Retrospective analysis of a prospectively collected database of all patients admitted for appendicular retroperitonitis during the period March 2017-September 2020. The variables associated with this complication and its management are analyzed. Results: 11 patients from 601 with a diagnosis of appendicitis presented with retroperitonitis during the study period (1.83%). Mean delay in diagnosis was 8 days (range 3-14 days). The location of the appendix was retrocecal in all cases and 81% had an appendicolith associated. 45% were initially managed with open abdomen. A 50% failure rate occurred after primary fascial closure. Morbidity and mortality rates were 81% and 18%, respectively. Discussion: Retrocecal location of the appendix, the presence of an appendicolith and atypical presentation with delayed diagnosis were common factors present in our experience. Primary fascial closure was associated with a 50% failure rate. Morbidity and mortality were high. Conclusion: Retroperitonitis is a rare but severe complication of appendicitis, with high morbidity and mortality rates.

Uso del pódcast como herramienta educativa en una residencia de Cirugía General en tiempos de COVID-19 / Use of podcasts as educational tool in a residency program in general surgery in the time of COVID-19 pandemic

RESUMEN Antecedentes: la pandemia de COVID-19 alteró la formación de los residentes de cirugía, disminuyendo sus oportunidades de aprendizaje. La lectura y análisis de trabajos científicos a través de pódcast podrían ser una opción para atenuar ese problema. Objetivo: evaluar la aceptación por parte de los residentes de Cirugía del uso de pódcast como una nueva herramienta educativa. Material y métodos: estudio exploratorio, analítico y longitudinal, realizado desde mayo hasta diciembre de 2020. Cada semana, un residente fue el encargado de leer, analizar y confeccionar una presentación grabada en forma de pódcast sobre un artículo seleccionado por médicos de planta. Se evaluó la experiencia de los residentes mediante un cuestionario tipo Likert diseñado por los investigadores. Resultados: se realizaron 37 pódcast, que se reprodujeron 2091 veces. El 100% de los residentes informó que esta herramienta fomentó la discusión académica entre pares, el 88% que le generó preguntas de investigación y el 43% que lo inspiró a una revisión bibliográfica. Conclusión: la lectura y análisis de trabajos a través de pódcast es bien aceptada y puede ser una herramienta adicional para el aprendizaje en épocas atípicas.

ABSTRACT Background: COVID-19 pandemic altered the training of residents in surgery, reducing their opportunities to learn. Reading and analyzing scientific paper via podcasts could be an option to mitigate such problem. Objective: The aim of this study is to evaluate residents in surgery acceptance of the use of podcasts as a new educational tool. Material and methods: We conducted a longitudinal, analytical and exploratory study between May and December 2020. Each week, a resident was in charge of reading, analyzing and preparing a recorded presentation in the format of a podcast of an article selected by a staff physician. The residents' experience was assessed by means of a Likert-type questionnaire designed by the investigators. Results: A total of 37 podcasts were recorded with a total number of plays of 2091. All the residents reported that this tool encouraged the academic peer discussion, 88% responded that it generated research questions and 43% agreed that listening to the podcasts served as inspiration to perform a bibliographic search. Conclusion: Reading and analyzing scientific papers via podcasts is well accepted and could be an additional tool for learning in atypical times.

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.

Use of absorbable meshes in laparoscopic paraesophageal hernia repair.

Paraesophageal hernia (PEH) repair is one of the most challenging upper gastrointestinal operations. Its high rate of recurrence is due mostly to the low quality of the crura and size of the hiatal defect. In an attempt to diminish the recurrence rates, some clinical investigators have begun performing mesh-reinforced cruroplasty with nonabsorbable meshes like polypropylene or polytetrafluoroethylene. The main problem with these materials is the occurrence, in some patients, of serious mesh-related morbidities, such as erosions into the stomach and the esophagus, some of which necessitate subsequent esophagectomy or gastrectomy. Absorbable meshes can be synthetic or biological and were introduced in recent years for PEH repair with the intent of diminishing the recurrence rates observed after primary repair alone but, theoretically, without the risks of morbidities presented by the nonabsorbable meshes. The current role of absorbable meshes in PEH repair is still under debate, since there are few data regarding their long-term efficacy, particularly in terms of recurrence rates, morbidity, need for revision, and quality of life. In this opinion review, we analyze all the presently available evidence of reinforced cruroplasty for PEH repair using nonabsorbable meshes (synthetic or biological), focusing particularly on recurrence rates, mesh-related morbidity, and long-term quality of life.

Entrenamiento en Cirugía Bariátrica. Importancia de las Carreras de posgrado Universitarias / Training in bariatric surgery: Importance of University Postgraduate Careers

Bariatric surgery is performed usually in a videolaparoscopic form. This involves that surgeons must have the abilities of advanced laparascopy. The learning curve was previously analyzed in numerous reports. This curriculums for the fellowships include the development of cognitive abilities and clinicotechnical training. Through the Course of Specialists for Metabolic and Bariatric Surgery from the Buenos Aires University, four fellows have been formed. In this study, the training modality is described

La cirugía bariátrica se realiza generalmente de forma videolaparoscópica. Esto implica que los cirujanos tengan habilidades de laparoscopía avanzada. La curva de aprendizaje se ha analizado en numerosos trabajos. Las currículas para los fellowship incluyen el desarrollo de habilidades cognitivas y clínico-técnicas. A través de la Carrera de Especialista en Cirugía Bariátrica y Metabólica de la UBA se han formado cuatro fellows. En este trabajo se describe la modalidad de aprendizaje

Low-concentration distal nerve blocks with 0.125% levobupivacaine versus systemic analgesia for ambulatory trapeziectomy performed under axillary block: a randomized controlled trial.

BACKGROUND: Trapeziectomy is one of the most painful procedures in ambulatory surgery. This prospective randomized trial aimed to compare postoperative pain control using distal peripheral nerve blocks (dPNB) with a low concentration of a long-acting local anesthetic versus conventional systemic analgesia. METHODS: Fifty-two patients undergoing trapeziectomy were randomized to receive levobupivacaine 0.125% 5 mL on radial and median nerves at the elbow (dNB group), or not to receive these blocks (control group). In both groups, surgery was performed under axillary block (mepivacaine 1% 20 mL) and the same analgesic regimen was prescribed at discharge. The primary outcome was postoperative pain at 24 and 48 hours after surgery and maximum pain score on the first and second postoperative day. Secondary outcomes were duration of dPNB, rescue analgesia requirements, opioid-related side effects, consumption and effectiveness of antiemetic therapy, and upper limb motor block. RESULTS: Fifty patients were analyzed. Maximum pain intensity was moderate to severe (dPNB vs. control) in 33.3% vs. 92.3% (P=0.002) on the first day after surgery and 20.8% vs. 80.8% (P<0.001) on the second day. The average duration of analgesia after dPNB was 10 hours and no patient reported motor block. dPNB reduced rescue analgesia requirements and the incidence of postoperative nausea and vomiting (PONV). CONCLUSIONS: dPNB on target nerves provided better analgesia than systemic analgesia after trapeziectomy performed under axillary block. Opioid consumption and the incidence of PONV were lower in the dPNB group.

La socialización de los profesionales sanitarios y el papel de la resiliencia en el desarrollo de conductas de bienestar en el trabajo / Health personnel socialization and the role of resilience in the development of occupational well-being

Introducción. La socialización durante la formación de especialistas es una etapa clave en el posterior ajuste y bienestar laboral de los sanitarios en la organización hospitalaria. Objetivo. Analizar la relación de la socialización y la resiliencia con las respuestas de engagement en especialistas en formación. Método. Se llevó a cabo un muestreo de conveniencia, participando en el estudio 110 profesionales provenientes de 6 unidades docentes de diferentes hospitales. Se llevaron a cabo análisis descriptivos y mediacionales de las variables de estudio mediante SPSS 21 y Macro de Preacher y Hayes (2004). Resultados. Se muestran relaciones estadísticamente significativas entre socialización, resiliencia y engagement. También se muestra el papel mediador de la resiliencia (β=0,10; se=0,12; p<0,05; IC: [0,02-0,23]) para generar engagement en los profesionales sanitarios. Conclusiones. Se observa una interacción entre socialización y especialidad que modera la resiliencia. Así, se señalan cómo una socialización positiva y la resiliencia pueden promover un buen desempeño (AU)

Introduction. Socialization during the training of specialists is a key step in the subsequent adjustment and occupational well-being of health professionals in the hospital organisation. Objective. To analyse the relationship of socialization and resilience with the engagement responses of specialists in training. Method. Convenience sampling was used, with 110 professionals from six teaching units of different hospitals participating in the study. Descriptive and mediational analysis of the study variables were performed using SPSS 21 and Macro Preacher and Hayes (2004). Results. The results show statistically significant relationships between socialization, resilience, and engagement. The mediating role of resilience is also shown (β=0.10; se=0.12; p<0.05, 95% CI: [0.02-0.23]) to generate engagement in health professionals. Conclusions. An interaction effect is observed between socialization, and specialty moderates resilience. Therefore it can be seen that positive socialization and resilience can promote good performance (AU)

[Health personnel socialization and the role of resilience in the development of occupational well-being]. / La socialización de los profesionales sanitarios y el papel de la resiliencia en el desarrollo de conductas de bienestar en el trabajo.

INTRODUCTION: Socialization during the training of specialists is a key step in the subsequent adjustment and occupational well-being of health professionals in the hospital organisation. OBJECTIVE: To analyse the relationship of socialization and resilience with the engagement responses of specialists in training. METHOD: Convenience sampling was used, with 110 professionals from six teaching units of different hospitals participating in the study. Descriptive and mediational analysis of the study variables were performed using SPSS 21 and Macro Preacher and Hayes (2004). RESULTS: The results show statistically significant relationships between socialization, resilience, and engagement. The mediating role of resilience is also shown (ß=0.10; se=0.12; p<0.05, 95% CI: [0.02-0.23]) to generate engagement in health professionals. CONCLUSIONS: An interaction effect is observed between socialization, and specialty moderates resilience. Therefore it can be seen that positive socialization and resilience can promote good performance.

Increased expression of HOXB2 and HOXB13 proteins is associated with HPV infection and cervical cancer progression.

BACKGROUND: Cervical cancer (CeCa) is the second most common cancer in women in developing countries, and human papilloma virus (HPV) is the primary etiological factor. Aberrant expression of HOX transcription factors has been observed in several types of cancer. To date, however, no reports exist on the expression of HOXB2 and HOXB13 proteins during neoplastic progression in CeCa and its correlation with HPV infection. MATERIALS AND METHODS: Expression of HOXB2 and HOXB13 proteins was assessed in tissue microarrays from normal cervical epithelium, cervical intraepithelial neoplasias grade 1-3, and CeCa. HPV was detected by PCR and sequencing. Expression of HOX-positive cells was determined in each diagnostic group. RESULTS: Percentage of HOXB2- and HOXB13-positive cells gradually increased from means of 10.9% and 16.7%, respectively, in samples from healthy women, to 75.2% and 88.6% in those from CeCa patients. Frequency of HPV infection also increased from 13% in healthy tissue samples to 92.3% in CeCa. Both HOXB2 and HOXB13 proteins were preferentially expressed in HPV+ samples. CONCLUSIONS: The present study represents the first report on the expression of both HOXB2 and HOXB13 proteins through cervix tumorigenesis, providing evidence that increased expression of such proteins is a common event during progression to CeCa.

Differences between clinical and laboratory findings in patients with recent diagnosis of SLE according to the positivity of anti-dsDNA by the Crithidia luciliae method.

BACKGROUND: Of all anti-dsDNA antibody detection methods, the Crithidia luciliae immunofluorescence test (CLIF) is considered to have the highest specificity for systemic lupus erythematosus (SLE). OBJECTIVE: The objective of this report is to evaluate whether the presence of anti-dsDNA antibodies detected by the CLIF method is associated with a specific clinical phenotype in recently diagnosed SLE. METHODS: This retrospective cross-sectional study included all patients with newly diagnosed SLE between 1990 and 2011 and followed up in our institution. Demographic, clinical and laboratory findings were assessed. Correlations between positivity of anti-dsDNA by the CLIF method, clinical and laboratory data were analyzed. RESULTS: A total of 104 patients were included in the analysis. Patients who were positive for anti-dsDNA by the CLIF method at the time of diagnosis had (statistically) significantly higher titers of anti-dsDNA by the ELISA method, antinuclear (ANA) and anticardiolipin antibodies, lymphopenia and complement consumption compared with the other two groups. Also they presented significantly more musculoskeletal symptoms at baseline. CONCLUSION: The presence of anti-dsDNA by the CLIF method in newly diagnosed SLE was associated with certain markers of increased disease activity. Its use could be a useful biomarker for a specific clinical phenotype suggestive of a more severe involvement at the time of the diagnosis.

Colecistts xantogranulomatosa / Xantogranulomatous cholecystts

Antecedentes: la colecistts xantogranulomatosa es una enfermedad infamatoria con destrucción de la pared vesicular, cuya prevalencia oscila entre el 0.7 y 13,2% de las colecistectomías. Objetvos: analizar la incidencia, forma de presentación y resultados del tratamiento de esta patología en un Centro de Cirugía HPB de la Ciudad de Buenos Aires. Lugar de aplicación: Departamento de Cirugía HIGA Dr. Cosme Argerich. Diseño: retrospectvo Población: colecistectomías realizadas en el HIGA Argerich, entre abril de 2008 y abril de 2010. Método: análisis histopatológico de las piezas de colecistectomía. Estratificación de la presentación clínica en formas incidentales o pseudotumorales. Análisis de las complicaciones intraoperatorias y posoperatorias, estadía hospitalaria y mortalidad. Resultados: de 815 colecistectomías videolaparoscópicas 32 (3,9%) fueron colecistts xantogranulo-matosas. Dieciocho fueron hombres y 14 mujeres. Edad media 40,6 años. Los pacientes se evaluaron por ecografa y en las formas pseudotumorales se agregó una tic abdominal. Veintsiete fueron formas incidentales y 5 pseudotumorales. El tempo operatorio promedio fue de 114 minutos y no hubo conversiones. Dos bilirragias intraoperatorias se controlaron en las formas pseudotumorales y una bilirragia y 2 pseudoaneurismas rotos de la arteria hepática fueron reoperados en las formas incidentales. La estadía posoperatoria promedio fue de 2,6 días. Conclusión: la colecistts xantogranulomatosa puede presentarse como un proceso infamatorio habitual o remedar un cáncer de vesícula. Las imágenes son imprescindibles para el diagnóstico diferencial. Fueron más frecuentes las complicaciones intraoperatorias en las formas pseudotumo-rales y las posoperatorias en las incidentales. El cirujano debe conocer esta entdad y sus eventuales complicaciones.

Análisis de la dispensación de antibióticos en pacientes ambulatorios en una farmacia comunitaria en Murcia, España / Analysis of the dispensation of out patient antibiotics in a community pharmacy at Murcia, Spain

Antecedentes: El uso inadecuado de los antibióticos es considerado como una de las principales causasde la aparición de resistencia microbiana. Este es considerado a su vez como un problema de salud pública,y los farmacéuticos tienen una importante oportunidad de intervención durante la dispensaciónde estos medicamentos. Objetivos: Identificar y resolver las incidencias relacionadas con el uso de antibióticosdurante la dispensación en una farmacia comunitaria, y caracterizar el perfil de paciente y tipode antibiótico solicitado. Métodos: Se realizó un estudio cuasi-experimental (sin grupo control), queincluyó a los pacientes que acudieron a la farmacia a retirar un antibiótico durante el periodo de estudio.La intervención en los pacientes que solicitaban el antibiótico por primera vez consistió en verificar siexistían criterios para la no dispensación e informar sobre el proceso de uso del medicamento. En dispensaciónrepetida se evaluó la efectividad y seguridad del antibiótico. En ambos casos se realizó la deteccióny resolución de incidencias, a través de un episodio de seguimiento. Cuando se solicitó el antibióticosin receta, se intervino para intentar evitarlo, ofreciendo al paciente otras alternativas. Resultados: El76,2% (64) de las solicitudes fueron con receta, con una media de edad de 44,5 (DE = 18,2) años, en sumayoría mujeres (65,6%), con estudios universitarios (68,8%). El grupo terapéutico más prescrito fue elde los beta-lactámicos (48,4%), y la infección más frecuente fue la respiratoria (45,3%). El 20,3% (13) delgrupo de población que demandó con receta tuvo un episodio de seguimiento; esta incidencia se resolvióen el 100% de los casos. El 23,8% (20) de las solicitudes fueron automedicación, la cual se evitó en un25% hablando con el paciente. El 58,3% (7) de los pacientes fueron remitidos al médico, mientras que el41,7% (5) no aceptó la propuesta...

Misuse of antibiotics is considered as one of the main drivers for the emergence of microbial resistance. This is in turn considered as a public health problem, and chemists have a fruitful opportunity in intervening the dispensation of these medicines.Objectives: To identify and resolve incidents regarding the use of antibiotics during the dispensation in a community pharmacy, as well as to classify the demand for antibiotics according to the patient ́s profile and the type of demanded antibiotic. Methods: A quasi-experimental study (without a control group) was carried out, including the patients who came to the chemist to withdraw an antibiotic during the period of study. The intervention in patients requesting the antibiotic for the first time consisted in verifying any possible criteria for its non-provision, and informing about the process of using the medicine. While supplying the product repeatedly, both its effectiveness and safety were tested together with incidents identification and resolution through a follow-up process. When the antibiotic was required without prescription, an action was taken in order to avoid it and offer to the patient other alternatives.

Changes in gastrosplenic circulation and splenic function after distal pancreatectomy with spleen preservation and splenic vessel excision.

INTRODUCTION: Distal pancreatectomy with spleen preservation and splenic vessel excision is a commonly used technique. However, it produces significant gastrosplenic circulation and splenic function changes. PURPOSE: The aim of this work was to determine the immediate consequences on gastrosplenic circulation, late consequences on splenic function, and development of varicose veins. METHODS: Thirty-five patients with pancreatic tumors and anatomical feasibility were included. Preoperative splenic circulation was evaluated by dynamic contrast-enhanced computed tomography (CT) scans. Early splenic perfusion was assessed by CT 7 days after surgery and late changes in gastrosplenic circulation 6 months after surgery. Varicose veins were evaluated by CT and endoscopy 6 months after surgery. Pitted cells and Howell-Jolly bodies were used as markers of splenic function. Postoperatory findings included changes in splenic perfusion 7 days and 6 months after surgery, development of varicose veins on CT scans and endoscopy, and detection of markers of splenic hypofunction on blood smears. RESULTS AND CONCLUSION: Seven days after surgery, 63% of patients had some degree of splenic hypoperfusion, and 6 months after surgery, 83% of patients had normal perfusion. CT scans showed varices in 26 patients, and endoscopy revealed varicose veins in 11. Two patients experienced bleeding; markers of splenic hypofunction were found in 59% of cases.