Laparoscopic approach of persistant retroperitoneal adrenal ganclioneuroma

We report on 26-year-old woman with a right adrenal tumour 10cm in diameter who was treated by laparoscopic resection. The patient was asymptomatic and she has passed medical history of a suprarenal tumour and she was operated in her country 6 years before and six months later there was evidence of recurrence. Any medical treatment was given at this time. We don't have any medical report of this event. A subsequent computed tomography (CT) of the abdomen confirmed a 10x8cm homogenous mass in the suprarenal right spaceLaparoscopic complete excision of the mass was performed. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology was consistent with an adrenal ganglioneuroma. Three years later, there is not evidence of recurrence on abdominal CT scan

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Refuerzo de Anastomosis esofagogástrica con Tachosil por vía toracoscópica / Thoracoscopic esophagogastric anastomoses covered with Tachosil

El abordaje mínimamente invasivo en el tratamiento de la patología oncológica esofagogástrica aporta grandes ventajas respecto al dolor postoperatorio y las complicaciones pulmonares fundamentalmente derivadas del abordaje clásico por toracotomía. La realización de la anastomosis digestiva intratorácica por vía toracoscópica es todavía un reto técnico y grave problema postoperatorio de difícil manejo. Aportamos la descripción de un caso realizado por nuestro equipo en el que la anastomosis se reforzó con una placa de Tachosil(R), una material hemostático con probada eficacia en la disminución de tasas de fístula postoperatoria en anastomosis digestivas

The minimally invasive boarding in the treatment of oesophagus and gastric cancer contributes big advantages with regard to the postoperatory pain and the pulmonary complications fundamentally derived from the classic boarding for thoracotomy approach The accomplishment of the intrathoracic thoracoscopic digestive anastomoses is still a technical challenge and serious problem with difficult managing and control. We contribute the description of a case performed by our team in which the anastomoses reinforced with Tachosil's plate materially hemostatic with proven efficiency in the decrease of rates of postoperatory digestive leak

Mejora de la calidad de vida y pérdida de peso en pacientes obesos sometidos a gastrectomía tubular, un procedimiento seguro en cirugía bariátrica / Improvement of th quality of life and loss of weight in obese patients with sleeve gastrectomy, a safe procedure in bariatric surgery

Introducción: En relación con el Porcentaje de Exceso de Peso Perdido, la gastrectomía tubular ha demostrado ser superior a la banda gástrica ajustable, obteniendo resultados similares al bypass en el primer año. La evaluación de la calidad de vida se realiza mediante diferentes escalas, entre ellas el sistema BAROS. Evaluamos la satisfacción de los 100 primeros pacientes intervenidos en nuestro hospital con esta técnica. Material y Métodos: Se indicó la gastrectomía tubular siguiendo nuestro protocolo de tratamiento. Se realiza según técnica habitual con cinco puertos. La recogida de datos se ha basado en la revisión sistemática de las historias clínicas. La evaluación de la calidad de la cirugía se analiza con escala BAROS. El análisis de la pérdida ponderal se realiza utilizando el porcentaje de exceso de peso perdido (%EPP)[(peso inicial-peso actual/peso inicial-peso ideal)x100]. Resultados: El IMC medio de los pacientes intervenidos fue 43 kg/m2 con una desviación típica de 4,8 y mínimo y máximo de 32 kg/m2 y 63 kg/m2 respectivamente. En las revisiones posteriores, el porcentaje del exceso de peso perdido (%EPP) era del 37% a los 6 meses, con una desviación típica de 17 y una p50 del 54% y a los 18 meses en el 63% con una desviación típica de 19 y una p50 del 64%. El cuestionario BAROS fue aplicado al 98% de los pacientes de la muestra inicial. Encontramos que el 21% de los pacientes estudiados presentaron una puntuación excelente, el 43% muy buena, el 21% buena, el 10% regular

Introduction: In relation with excess weight loss, sleeve gastrectomy there has demonstrated being superior to the adjustable gastric band obtaining results similar to bypass in the first year. The evaluation of the quality of life is realized by means of different scales, including BAROS scale. We evaluate the satisfaction of the first 100 patient operated in our hospital. Methods: Sleeve gastrectomy was indicated following our protocol of treatment. It was performed under the usual surgical technique with five ports. The withdrawal of information has been based on the systematic review of clinical reports. Evaluation of quality of life was analyzed by BAROS scale. Analysis of weight loss was realized using the percentage of excess weight loss (%EWL) Results: The average BMI was 43kg/m2 with standard deviation of 4.8 and minimum and maximum of 32kg/m2 and 63 kg/m2 respectively. In posterior reviews, %EWL was 37% on 6 moths, with standard deviation of 17 and p50 54% and on 18 months in 63% with standard deviation of 19 and p50 64%. The BAROS scale was applied to 98% of the patients. 21% of studied patients presented an excellent, 43% very good, 21% good and 10% regulate

Injury patterns from major urban terrorist bombings in trains: the Madrid experience.

BACKGROUND: Terrorist urban mass casualty incidents (MCI) in the last 3 years have targeted commuter trains at rush hour, producing large numbers of casualties. Civilian care providers are usually not familiar with the types of blast injuries sustained by victims of these MCI. METHODS: We focus on the injury patterns sustained by casualties of the Madrid, 11 March 2004, terrorist bombings, at the seven hospitals that received most victims. Data were gathered of casualties who had injuries other than superficial bruises, transient hearing loss from barotrauma without eardrum perforation, and/or emotional shock. The degree of severity in critical patients was assessed with the ISS. RESULTS: The bombings resulted in 177 immediate fatalities, 9 early deaths, and 5 late deaths. Most survivors had noncritical injuries, but 72 (14%) of 512 casualties assessed had an Injury Severity Score (ISS) >15. The critical mortality rate was of 19.5%. The most frequently injured body regions were the head-neck and face. Almost 50% of casualties had ear-drum perforation, and 60% of them were bilateral. There were 43 documented cases of blast lung injury, with a survival rate of 88.3%. Maxillofacial and open long-bone fractures were most prevalent. Gustillo's grade III of severity predominated in tibia-fibular and humeral fractures. Upper thoracic fractures (D1-6 segment) represented 65% of all vertebral fractures and were associated with severe blast to the torso. Severe burns were uncommon. Eye injuries were frequent, although most were of a mild-to-moderate severity. Abdominal visceral lesions were present in 25 (5%) patients. A multidisciplinary approach was necessary in most operated patients, and orthopedic trauma procedures accounted for 50% of the caseload in the first 24 h. CONCLUSIONS: Ninety-three percent of the fatalities of the Madrid trains terrorist bombings were immediate, and most survivors had noncritical injuries. Closed doors increased the immediate fatality rate in the trains. Severely wounded casualties presented specific patterns of injuries, some of them life-threatening and unusual in other types of trauma mechanisms. Ear-lobe amputations and upper thoracic spine fractures were markers of critical injuries.

Extraosseous retroperitoneal Ewing's sarcoma.

Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) belongs to the group of paediatric small round blue-cell tumours. ES/PNET is classically a tumour of the soft tissue or bone in children and young adults. The case of a 21-year-old woman with a retroperitoneal localisation of Ewing's sarcoma is described.

Extraosseous retroperitoneal Ewing's sarcoma

Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) belongs to the group of paediatric small round blue-cell tumours. ES/PNET is classically a tumour of the soft tissue or bone in children and young adults. The case of a 21-year-old woman with a retroperitoneal localisation of Ewing's sarcoma is described (AU)