[Perforation after colonoscopy: our 16-year experience]. / Perforación tras colonoscopia: experiencia en 16 años.

OBJECTIVE: the aim of this retrospective study was to evaluate the incidence of colon perforations from diagnostic and therapeutic colonoscopies, and to assess their management in our hospital. PATIENTS AND METHOD: perforations resulting from colonoscopy in our hospital were reviewed for the period January, 1991 to December, 2006. The study analyzed: purpose of procedure, lesion mechanisms, clinical and radiological presentations, delays in diagnosis, patient status, therapeutic handling, and outcome. RESULT: fifteen perforations (0.09%) (9 males and 6 females) out of a total of 16,285 colonoscopies carried out were seen to have taken place during the study period. Nine of these occurred after diagnostic colonoscopies, and 6 occurred after therapeutic endoscopies. Around 60% of perforations were detected by the endoscopist while carrying out the procedure (88.6% during diagnostic endoscopy, and 16.6% during therapeutic endoscopy). In 73.7% of cases abdominal pain and distension were the most frequent symptoms; extraluminal gas was seen in 100% of cases with imaging techniques. Delayed diagnosis (> 24 hours) occurred in 40% of patients (range: 1-6 days). Twelve patients were operated upon (80%), of whom 4 were ASA II and 8 were ASA III/IV. Postoperative morbidity was 44.44%, and mortality was 25%. The outcome of patients receiving conservative treatment was found to be satisfactory. CONCLUSION: perforation of the colon during colonoscopy is a rare complication with serious -even lethal- consequences. Conservative treatment can be provided for selected cases under strict clinical control. Type of surgery will depend on the lesion location and size, concomitant colon pathology, and degree of fecal contamination. Mortality seems to be related to general status rather than the surgical technique used.

Perforación tras colonoscopia: experiencia en 16 años / Perforation after colonoscopy: our 16-year experience

Objetivo: el propósito de este estudio retrospectivo fue conocerla incidencia de perforaciones de colon por colonoscopia diagnósticay terapéutica y valorar el manejo de las mismas en nuestro medio.Pacientes y método: se revisaron las perforaciones por colonoscopiasrealizadas en nuestro hospital entre enero de 1991 ydiciembre de 2006. Se analizaron la finalidad del procedimiento,el mecanismo de la lesión, su presentación clínica y radiológica, elretraso diagnóstico, el estado general de los pacientes, el manejoterapéutico y sus resultados.Resultados: en el periodo de estudio hubo 15 perforaciones(0,09%) de un total de 16.285 colonoscopias realizadas (9 varones,6 mujeres). Nueve ocurrieron tras colonoscopias diagnósticasy 6 terapéuticas. El 60% de las perforaciones fueron advertidaspor el endoscopista durante el procedimiento (en el 88,6% de lasdiagnósticas y en el 16,6% de las terapéuticas). En el 73,7% delos casos el dolor con distensión abdominal fue el síntoma másfrecuente y en 11 pacientes con pruebas de imagen se apreciógas extraluminal en el 100% de los casos. El retraso diagnóstico(> 24 horas) ocurrió en el 40% de los pacientes (rango: 1-6 días).Fueron intervenidos 12 pacientes (80%) de los que 4 eran ASA IIy 8 ASA III/IV. La morbilidad postoperatoria fue del 44,44% y lamortalidad del 25%. La evolución de los pacientes tratados conservadoramentefue satisfactoria.Conclusión: la perforación de colon por colonoscopia es unacomplicación rara de consecuencias graves e incluso letales. Eltratamiento conservador puede realizarse en casos seleccionadosy bajo un control clínico estricto. El tipo de cirugía va a dependerde la localización, tamaño de la lesión, patología colónica concomitantey grado de contaminación fecal. La mortalidad parece estarmás relacionada con el estado general del paciente que con lapropia técnica quirúrgica realizada

Objective: the aim of this retrospective study was to evaluate theincidence of colon perforations from diagnostic and therapeutic colonoscopies,and to assess their management in our hospital.Patients and method: perforations resulting from colonoscopyin our hospital were reviewed for the period January, 1991to December, 2006. The study analyzed: purpose of procedure,lesion mechanisms, clinical and radiological presentations, delaysin diagnosis, patient status, therapeutic handling, and outcome.Result: fifteen perforations (0.09%) (9 males and 6 females)out of a total of 16,285 colonoscopies carried out were seen tohave taken place during the study period. Nine of these occurredafter diagnostic colonoscopies, and 6 occurred after therapeuticendoscopies. Around 60% of perforations were detected by theendoscopist while carrying out the procedure (88.6% during diagnosticendoscopy, and 16.6% during therapeutic endoscopy). In73.7% of cases abdominal pain and distension were the most frequentsymptoms; extraluminal gas was seen in 100% of caseswith imaging techniques. Delayed diagnosis (> 24 hours) occurredin 40% of patients (range: 1-6 days). Twelve patients were operatedupon (80%), of whom 4 were ASA II and 8 were ASA III/IV.Postoperative morbidity was 44.44%, and mortality was 25%.The outcome of patients receiving conservative treatment wasfound to be satisfactory.Conclusion: perforation of the colon during colonoscopy is arare complication with serious –even lethal– consequences. Conservativetreatment can be provided for selected cases under strictclinical control. Type of surgery will depend on the lesion locationand size, concomitant colon pathology, and degree of fecal contamination.Mortality seems to be related to general status ratherthan the surgical technique used

Non-heart-beating donors: an excellent choice to increase the donor pool.

A specific program was adopted to obtain organs, for transplant purposes from people who die at home or in the street from sudden or unexpected death (type I non-heart-beating donors [NHBD] according to the Maastricht classification). The objective of our program was to increase the donor pool by obtaining organs from well-selected potential donors who die at home, work, or in the street and are maintained on advanced life support (ALS) until hospital arrival. The great number of people who die in a previously healthy situation constitute an excellent source of organs for transplant purposes. Our program includes pre- and in-hospital attendance. Prehospital attendance is based on application of cardiopulmonary resuscitation in situ and ALS until arrival at hospital. In hospital, specific preservation maneuvers must be performed and family assessment and judge permission obtained. In the last 15 years, we developed a kidney transplant program with better results than transplants performed with organs obtained from encephalic death donors (EDD). A specific NHBD subprogram for lung transplant was developed with excellent results as well. We are now improving the liver transplant program. NHBD are an important source of human tissues, including pancreas islets. It is clear that NHBD are a great source of organs and tissues for transplant, and that this kind of program must be established in all countries in which legal regulations allow it.

Eficacia del tratamiento con oligoelementos de la enfermedad de meniere / Efficacy of the treatment with olygoelements of the ménière' s diseases

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[Otoacoustic emissions in sudden deafness]. / Emisiones otoacústicas en sorderas súbitas.

UNLABELLED: The idiopathic type of sudden deafness installed in few hours become evident in audiometry as deafness perceptive of loud tones, neurosensorial deafness of loud tones and completely of treble sounds or cofosis. The otoacoustic emissions are modificated in sudden deafness. OBJECTIVES: To know and describe how are the otoacoustic emissions and the audition in sudden deafness. To analyse a possible relationship between audition, otovestibular and clinic participation with the parameters of the graphoelements of the otoacoustic emissions. PATIENTS AND METHODS: We study 52 patients with diagnostic of sudden deafness with a backward, observational and descriptive and analytic design of the results. Patients with ORL diagnostic were selectioned and audiometric, vestibular test and otoacoustic emissions were made. RESULTS: In our research we find quantitative and qualitative variations statistically significative in the otoacoustic emissions design. Its presence in the different frequencies is altered or is missing in any case of sudden deafness in which there are damages of the inner ear. There is not associative correlation between the alterations of otoacoustic emissions and the kind of sudden deafness, neither its provoking factors, anigiohematical, viral or traumatic. DISCUSSION AND CONCLUSIONS: There are modifications of the otoacoustic emissions but not specificals or the kinds of sudden deafness and its provoking factors. Another publications agree and underwrite our discoveries. We thought that our aportation with this study is fundamental for the clinic application of the otoacoustic emissions in the processes of sudden deafness.

Emisiones otoacústicas en sorderas súbitas / Otoacustic emissions in sudden deafness

La forma idiopática de sordera súbita instalada en pocas horas se manifiesta en audiometría como sordera perceptiva de tonos graves, sordera neurosensorial de tonos graves y total de tonos agudos o cofosis. Están codificadas las emisiones otoacústicas en las sorderas súbitas. Objetivos. 1º Conocer y describir cómo estás las emisiones otoacústicas y la audición en las sorderas súbitas. 2º Analizar una posible relación asociativa entre audición, participación otovestibular y clínica con los parámetros de los grafoelementos de las emisiones otoacústicas. Pacientes (material y métodos). Estudiamos 52 pacientes con diagnóstico de sordera súbita con un diseño retrospectivo, observacional y descriptivo, y analítico de resultados. Se seleccionaron los pacientes con diagnóstico ORL y se les practicaron pruebas audiométricas, vestibulares y emisiones otoacústicas. Resultados. En nuestra investigación hallamos unas variaciones cuantitativas y cualitativas estadísticamente significativas en los trazados de emisiones otoacústicas. Su presencia en las diversas frecuencias está alterada o falta en todos los casos de sorderas súbitas en que hay lesiones de oído interno. No existe correlación asociativa entre las alteraciones de emisiones otoacústicas y tipo de sordera súbita ni sus factores desencadenantes angiohemático, viral o traumético. discusión/conclusiones. Existen modificaciones de las emisiones otoacústicas pero no específicas de las variedades de sorderas súbitas y sus factores desencadenantes. Otras publicaciones coinciden y avalan nuestros hallazgos. Pensamos que nuestra aportación con este estudio es básica para la aplicación clínica de las emisiones otoacústicas en los procesos de sorderas súbitas (AU)

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[Efficacy of the treatment of Ménière's disease with oligoelements]. / Eficacia del tratamiento con oligoelementos de la enfermedad de Ménière.

OBJECTIVES: 1st To study and know better the therapeutical action of the olygoelements in the Ménière's diseases. 2nd To analyse if there are significative statistical associations of therapeutical response to the olygoelements in the Ménière's sickness. MATERIAL AND METHODS: We make a design of observational study of 68 patients with the diagnostic of Ménière's sickness, with classical therapeutic and 34 treated with and without litium olygoelements and manganese&cupper. RESULTS: In the descriptive statistics we find better results in the Ménières treated with olygoelements than in those that were not treated. In the analytic associative statistics we find that for 3 degrees of freedom a chi-square of 13.20 that is equal to 0.00459 (less than 0.05) that indicate that there's significative differences between both treatments not due to casuality. DISCUSSION: There are significative differences of better results in Ménières treated with olygoelements. The new aspect of potentiate the therapeutical arsenal of Ménières evidences a new possibility of soon clinical aplication.

[New indication for adenoidectomy-tonsillectomy in children: elimination of obstruction in obstructive sleep apnea syndrome]. / Nueva indicación de adenoidoamigdalectomía infantil: desobstrucción en el síndrome de apnea obstructiva del sueño.

Obstructive sleep apnea syndrome (OSAS) in children produces serious organic consequences that affect pharyngeal breathing and functional development. The high rate of incidence of this problem is important. In children, the most frequent cause of OSAS is hypertrophy of the tonsils, adenoids, or both. We think that a new indication for pediatric adenoidectomy and tonsillectomy is pharyngeal breathing obstruction by hypertrophic lymphoid formations in the Waldeyer ring. In a statistical analysis of 180 children with OSAS who underwent tonsillectomy and adenoidectomy, the disappearance of most symptoms 7 months after surgery was significant.

[The study of postoperative infection in patients after laryngeal cancer surgery]. / Estudio de la infección en el postoperatorio de los operados por cáncer de laringe.

We evaluated wound infections in major oncological surgery for laryngeal neoplasm and functional neck dissection. Our objective was to determine the incidence and prevalence of infection in a group of laryngectomized patients; we evaluated the temperature, duration of fever, and analytical findings in the postoperative period, antibiotic prophylaxis, and the treatment of infectious complications. A retrospective study was designed to examine the infectious complications that appeared in 97 patients who underwent laryngectomy and neck dissection for laryngeal carcinoma from 1994 to 1996 in an ENT department. Factors that influence wound infection were examined: fever, granulocytopenia, preoperative assessment, bacteriological culture, therapy and prophylaxis, and treatment. The data were analyzed statistically and compared with findings by other authors.

[Effectiveness of uvulopalatopharyngoplasty in snoring disorders and obstructive sleep apnea]. / Eficacia de la uvulopalatofaringoplastia en las roncopatía y apnea obstructiva del sueño.

We studied the effectiveness of uvulopalatopharyngoplasty under general anesthesia and classical surgery in 26 patients treated surgically for chronic snoring (CS) and obstructive sleep apnea syndrome (OSAS). Our technique is a variation of the Fujita and Quesada technique that involves partial resection of the palate and uvula with endonasal microsurgery. The criteria for inclusion were age 35 to 47 years and desire to do without C-PAP or Bi-PAP. This device, although effective, produced poor physical and psychological tolerance. After a postoperative follow-up of 3 years, good results were found in all cases.

[Normal values for basal serum gastrin with and without stimulation]. / Estudio de los valores normales de la gastrina sérica basal y tras estimulación.

In the present work we report a study of the basal gastrin serum levels and stimulated serum gastrin levels after an hyperproteic meal, in a group of 20 healthy volunteers, with neither actual nor previous digestive symptoms. 60% were males, with a mean age of 35, 7 years, the highest percentage (40%) belonging to the fourth decade of life. The procedure used to determine serum gastrin levels is described. The mean value of the 3 samples obtained in basal conditions was of 51.01 pg/ml. The mean value of the 6 samples obtained after the stimulation meal was of 73.4 pg/ml. The results obtained in this study are discussed and compared with the ones of the reviewed literature.