Long-term outcomes of an acellular dermal matrix for the treatment of complex cryptoglandular anal fistula: a pilot study.

BACKGOUND: Effective, standardized treatments for complex anal fistula (CAF) still represent a clinical challenge. Emerging procedures attempted to achieve the healing rates of fistulotomy whilst preserving sphincter function. Acellular dermal matrix (ADM) used as a plug inserted through the fistulous tract is among newer treatment options. Varying success rates have been reported, most with short-term follow-up. The aim of this study was to report the long-term results of ADM-plug for CAF. METHODS: Retrospective analysis of a prospective database of patients treated with CAF. All consecutive patients presenting at two tertiary centers (Vall d'Hebron University Hospital and Bellvitge University Hospital, Barcelona, Spain) between November 2015 and March 2019 with a single, cryptoglandular CAF were evaluated for treatment with an ADM-plug were included. The primary endpoint was absence of discharge at clinical examination at 12 month follow-up. RESULTS: Twenty-two patients were included [7 women and 15 men, median age 56 (33-74) years]. Most patients had high transsphincteric fistulas (63.6%). The median follow-up was 42 (21-53) months. The 12 month success rate was 68.2%, with an overall healing rate of 59.1%. 77.8% of recurrences occurred within 12 months from surgery. One plug extrusion was observed. No major complications or mortality occurred during the follow-up. Patients did not report any worsening of fecal continence. CONCLUSIONS: This pilot study showed that more than half of patients with CAF could benefit from ADM-plug placement, preserving continence. A minimum follow-up of 12 months is recommended, because most recurrences occur during the first year.

Insomnio: diagnóstico, manejo y tratamiento / No disponible

El insomnio es la alteración más prevalente, dentro de la patología de sueño con un interés creciente en el estudio de su etiología, así como de las causas que conllevan a la cronificación del mismo. El insomnio es causa de importantes repercusiones en el mundo laboral, yaque provoca numerosas bajas laborales, así como de disminución del rendimiento laboral. En los últimos años se ha dado una importancia creciente a tratamientos no farmacológicos que asociados a terapias farmacológicas podrían dar buenos resultados en el insomnio primario, tanto en fase aguda como crónica

Insomnia is the most prevalent sleep disorder. Recently the research has been focused on its etiology and on the reasons why it becomes chronic. Insomnia is one of the most important causes of problems in the work place due to the decrease in working days and to the impairment in the performance of these patients. In recent years theimportance of non-pharmacologic therapies has been growing due to their good results in primary insomnia in both the acute and chronic phase

Plasmocitoma solitario de seno esfenoidal / Solitary plasmacytoma of sphenoid sinus

Propósito: Presentar un caso de plasmocitoma solitario extramedular (PSE) en una rara localización de cabeza y cuello, y evaluar el procedimiento diagnóstico y terapéutico más adecuado de estos tumores. Contamos con el único caso publicado con imágenes clínicas y de RM antes y después del tratamiento. Casos clínicos: Varón de 42 años con una masa en seno esfenoidal. La RM reveló extensión intracraneal. Resultados: Tras la biopsia y un estudio de extensión sistémico negativo se diagnosticó al paciente de PSE. El paciente fue tratado con radioterapia, con remisión clínica total hasta la actualidad. Conclusiones: El diagnóstico de PSE sólo puede realizarse tras un estudio de extensión sistémica negativo. Existe controversia sobre el tipo adecuado de tratamiento. La radioterapia consigue remisiones locales en el 80-95 por ciento de los casos. El pronóstico después del tratamiento es bueno (AU)

Blood recirculation in malfunctioning catheters for haemodialysis.

Venous catheters are increasingly used for chronic haemodialysis, with dual lumen catheters being the most commonly used as blood recirculation (REC%) is relatively low. The aim of this study was therefore to evaluate blood recirculation in dual lumen catheters, both well-functioning and malfunctioning, with reversed lumens. In our study, blood recirculation in well-functioning catheters with standard lumens is similar to that found in previous studies. However, when lumens are reversed, blood recirculation increases significantly (6.7 +/- 4 vs 19 +/- 11%, p < 0.001). REC% in malfunctioning catheters (10.8 +/- 2%) was higher than normal function (p < 0.05) but lower than reversed flow in normal catheters (p < 0.01). Therefore, inadvertent reversal of lumens in a well-functioning catheter increases REC% in a significant manner, thus worsening haemodialysis efficiency. We conclude that, in inflow failure catheters, lumens can be reversed because REC% is acceptable. However, inadvertent reversal of lumens in a well-functioning catheter increases REC% to a level which may compromise the adequacy of haemodialysis.