Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst.

Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. We present an unusual case of a primary splenic hydatid cyst. Open splenectomy has traditionally been the treatment of choice for splenic hydatid cysts. In recent years, minimally invasive laparoscopic surgery has been used in appropriate cases. A healthy 48-year-old woman was scheduled for laparoscopic splenectomy. We controlled the intraoperative analgesia using pupillometry. We used it as a method to evaluate the depth of analgesia and to guide opioid administration based on the pupillary dilation reflex. This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.

¿Existe correlación entre la manometría anorrectal y los datos de la ecografía endoanal en sujetos sanos en función de la edad? / Does correlation exist between anorectal manometry and endoanal ultrasound findings in healthy subjects according to age?

Introducción: diferentes estudios han demostrado la correlación entre los datos de la manometría anorrectal y la ecografía endoanal en pacientes con incontinencia fecal, pero el interés ha sido escaso en describir lo mismo en sujetos sanos en relación a la edad. Objetivos: estudiar la posible correlación entre los datos de la manometría anorrectal y de la ecografía endoanal en un grupo homogéneo de mujeres sanas, también en función de la edad de las mismas. Material y métodos: estudio prospectivo observacional de una cohorte de sujetos sanos (n = 14). Grupo homogéneo de mujeres voluntarias sanas divididas en 2 subgrupos en función de la edad. Resultados: no se objetivó correlación entra la medida del esfínter anal interno y la presión basal de reposo, tanto en toda la muestra analizada como en el análisis detallado por grupos de edad. Tampoco se objetivó correlación estadísticamente significativa entre el grosor del esfínter anal externo y la presión de esfuerzo, en toda la muestra analizada y por grupos. Conclusiones: no existe correlación estadísticamente significativa entre el grosor de los esfínteres y su función en un grupo homogéneo de sujetos sanos, tampoco en función de 2 grupos de edad(AU)

Background: different studies have demonstrated the correlation between anorectal manometry and endoanal ultrasonography data in patients with fecal incontinence, but there is no almost interest describing the same in healthy subjects according to age. Aims: to study the possible correlation between anorectal manometry and endoanal ultrasonography data in a homogeneous group of healthy women, also according to age. Material and methods: prospective observational study of a healthy subjects cohort (n = 14). Homogeneous group of healthy volunteer women divided in 2 subgroups according to age. Results: there was no proved correlation between the internal anal sphincter’s measurement and the resting pressure in the whole sample as well as the analysis according to age. Neither there was any proved statistically significant correlation between the external anal sphincter’s thickness and the squeeze pressure, in the whole sample and by groups. Conclusions: it does not exist statistically significant correlation between the thickness of the sphincters and its function in a healthy subjects homogeneous group, neither in 2 groups according to age(AU)

Indicacion actual, técnica quirúrgica y resultados de la reparación anterior esfinteriana en el tratamiento de la incontinencia fecal / Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence

La incontinencia fecal es una enfermedad de elevada prevalencia en la población general. Esta enfermedad, comúnmente subestimada, provoca un gran impacto clínico y en la calidad de vida en los pacientes afectados. Varios trabajos han comunicado una prevalencia de esta enfermedad de entre el 2 y el 15% de la población general, con cifras mucho mayores cuando se refiere a poblaciones seleccionadas, como por ejemplo pacientes con edad avanzada. La causa más frecuente de esta enfermedad es la lesión del aparato esfinteriano anal de origen obstétrico. Clásicamente, la presencia de incontinencia fecal debida a lesiones esfinterianas, sobre todo de origen obstétrico en la mujer, era una indicación indiscutible de reparación anterior del esfínter. Actualmente, después de conocer los resultados a largo plazo de esta técnica, junto a los avances en el conocimiento de la incontinencia fecal y al desarrollo de nuevas técnicas diagnósticas y terapéuticas, esta intervención parece estar indicada para casos más seleccionados con defectos amplios. A pesar de esto, existe escasa literatura médica actualizada sobre estas nuevas indicaciones y sus resultados. El objetivo de este trabajo es exponer la evidencia científica existente en cuanto a la indicación actual, los aspectos de la técnica quirúrgica y los resultados de la reparación anterior esfinteriana en el tratamiento de la incontinencia fecal, y aportar también nuestro especial punto de vista en los aspectos controvertidos. Para esto, se realizó una búsqueda bibliográfica a través de la base de datos Medline en la que incluimos artículos publicados entre enero de 1985 y enero de 2009 (AU)

Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009 (AU)

[Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence]. / Indicacion actual, técnica quirúrgica y resultados de la reparación anterior esfinteriana en el tratamiento de la incontinencia fecal.

Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009.