Análisis comparativo de indicadores de eficiencia en cirugía mayor ambulatoria / Comparative analysis of efficiency indicators in ambulatory surgery

Objetivo: Buscar elementos comparativos para el control de calidad en unidades de cirugía mayor ambulatoria (CMA). Método: Estudio descriptivo comparativo del índice de ambulatorización (IA) y el índice de sustitución (IS) en el Servicio de Cirugía del Hospital Santa Cristina, de Madrid (España), respecto a indicadores clave (IC) del Sistema Nacional de Salud (SNS). Resultados: Se analizaron 7817 procedimientos de CMA (entre 2006 y 2014) y se obtuvo un IA anual medio del 54%, superior (p <0,0001) al IC «Porcentaje de ambulatorización quirúrgica». Igualmente, la ambulatorización herniaria (media 72%) superó al IC nacional (p <0,0001), mientras que el IS «Hemorroidectomía» (media 33,6%) fue claramente inferior (p <0,0001). Conclusiones: Los IC del SNS son útiles y han permitido determinar un buen desarrollo en la ambulatorización global y de hernia, existiendo oportunidades de mejora en hemorroidectomía. Debe cuidarse su recogida, sin incluir cirugías menores, y su utilidad aumentaría si se ofrecieran datos desglosados por especialidades y complejidad

Objective: To find comparative elements for quality control in major ambulatory surgery (MAS) units. Method: Descriptive and comparative study of the Ambulatory Care Index (AI) and Substitution Index (SI) in the Santa Cristina Hospital Surgery Service (Madrid, Spain) compared to Key Indicators (KI) of the National Health Service (NHS). Results: 7,817 MAS procedures (between 2006 and 2014) were analysed. The average annual AI was 54%, higher (p <0.0001) than «ambulatory surgery» KI. The hernia outpatient procedures (average 72%) were also superior to the national KI (p <0.0001), but ambulatory haemorrhoidectomy (average 33.6%) was clearly lower (p <0.0001). Conclusions: KI of the NHS are useful and allow to establish a proper development in the global AI and hernia outpatient surgery with opportunities for improvement in haemorrhoidectomy. Their collection should be careful, not including minor surgeries. Also, their usefulness could be increased if data was broken down by speciality and by complexity

[Comparative analysis of efficiency indicators in ambulatory surgery]. / Análisis comparativo de indicadores de eficiencia en cirugía mayor ambulatoria.

OBJECTIVE: To find comparative elements for quality control in major ambulatory surgery (MAS) units. METHOD: Descriptive and comparative study of the Ambulatory Care Index (AI) and Substitution Index (SI) in the Santa Cristina Hospital Surgery Service (Madrid, Spain) compared to Key Indicators (KI) of the National Health Service (NHS). RESULTS: 7,817 MAS procedures (between 2006 and 2014) were analysed. The average annual AI was 54%, higher (p <0.0001) than «ambulatory surgery¼ KI. The hernia outpatient procedures (average 72%) were also superior to the national KI (p <0.0001), but ambulatory haemorrhoidectomy (average 33.6%) was clearly lower (p <0.0001). CONCLUSIONS: KI of the NHS are useful and allow to establish a proper development in the global AI and hernia outpatient surgery with opportunities for improvement in haemorrhoidectomy. Their collection should be careful, not including minor surgeries. Also, their usefulness could be increased if data was broken down by speciality and by complexity.

Stabilizing factors of the molecular structure in silicon-based peptidomimetics in gas-phase and water solution. Assessment of the correlation between different descriptors of hydrogen bond strength.

The use of DFT (B3LYP and M06L) and ab initio (MP2) computational methods allowed us to perform a thorough conformational study of N-[dihydroxy (methyl)silyl]methylformamide (DHSF) and 3-[dihydroxy (methyl) silyl] propanamide (DHSP), that could be considered simplified models of the environment of the silanediol group in silicon gem-diols that have proven efficiency as protease inhibitors. We have found a total of 13 molecular conformations that represent minima in the potential energy surfaces of DHSF (six conformers) and DHSP (seven conformers). The key feature in their molecular structure is the occurrence of intramolecular hydrogen bonding between the hydroxyl and aminocarbonyl groups. We have estimated the strength of each individual hydrogen bond in the mentioned species using the descriptors proposed by three different methodologies, i.e., the quantum theory of atoms in molecules (QTAIM), the natural bond orbitals population analysis (NBO), and the so-called empirical Rozenberg's enthalpy-distance relationship. We have found a good correlation among the calculated values for the different descriptors within the whole set of conformers in the molecular systems in this study. We have also discussed the predicted order of stabilities of the different conformers of each species in terms of the so-called ring anomeric effect (RAE) and generalized anomeric effect (GAE). Finally, we also analyzed the discrepancies found in the order of stability when going from the isolated molecule approximation to water solution (PCM).

Biopsia guiada por laparoscopia de tumoraciones intraabdominales no digestivas / Laparoscopic biopsy of non-digestive intra-abdominal masses

Introducción. La laparoscopia es un recurso diagnóstico de múltiples enfermedades que requieren biopsia de masas intraabdominales no abordables mediante punciones guiadas por imagen. Evita la morbimortalidad asociada a la laparotomía favoreciendo el tratamiento precoz de los procesos malignos. Pacientes y método. Análisis descriptivo, retrospectivo de los resultados de una serie de pacientes de nuestro hospital, que presentan nódulo intraabdominal de etiología desconocida biopsiados mediante cirugía laparoscópica desde enero de 2001 hasta mayo de 2006. Ninguno de los pacientes es candidato a punción percutánea guiada por imagen. Resultados. Realizamos 23 biopsias: 8 retroperitoneales (34,7%), 5 mesentéricas (21,7%), 5 en hilio hepático, 4 pelvianas y 1 en cadena de vena ilíaca y asociamos 5 biopsias complementarias. Se obtuvo un 100% de material suficiente para diagnóstico anatomopatológico. La duración media de la intervención fue de 71 min. El 61% tuvo un ingreso menor de 24 h. La estancia hospitalaria (mediana) fue de 1,5 días. Conclusiones. El abordaje laparoscópico permite una exposición y una revisión completa de la cavidad peritoneal. La biopsia laparoscópica es segura y efectiva con excelente recuperación del paciente permitiendo iniciar precozmente el tratamiento definitivo (AU)

Introduction. Laparoscopic surgery offers an alternative diagnostic technique in multiple diseases requiring biopsy of non-digestive intra-abdominal masses in which image-guided biopsy cannot be performed. Laparoscopic biopsy aims to reduce the surgical aggression and complications associated with laparotomy and favors the early treatment of malignancies. Patients and method. We performed a retrospective descriptive study of our results in a series of patients in our hospital with intra-abdominal masses of unknown etiology who underwent laparoscopic surgery between January 2001 and April 2006. None of the patients were candidates for image-guided percutaneous biopsy. Results. We carried out 23 biopsies: 8 retroperitoneal (34.7%), 5 mesenteric (21.7%), 5 hepatic, 4 pelvic, and 1 in the iliac chain, as well as 5 complementary biopsies. In all patients, sufficient material for histologic diagnosis was obtained. The mean operating time was 71 minutes. Length of hospital stay was less than 24 hours in 61% of the patients. The median length of hospital stay was 1.5 days. Conclusions. The laparoscopic approach allows complete visualization and examination of the entire peritoneal cavity. Laparoscopic biopsy is a safe and effective procedure with excellent patient recovery and allows early definitive treatment (AU)

[Obstructive jaundice caused by duodenal amyloidosis succesfully treated with surgery]. / Ictericia obstructiva. Inicio clínico de una amiloidosis duodenal tratada quirúrgicamente.

We present a case of obstructive jaundice due to duodenal amyloidosis presenting as a bulbar pseudotumor (amyloidoma). The duodenal and biliary obstruction were treated by double bypass, hepatojejunostomy and gastroenterostomy. Our case suggests that surgical palliative treatment may be effective, and that anastomosis is probably safe, allowing the patient a good quality of life.

Ictericia obstructiva. Inicio clínico de una amiloidosis duodenal tratada quirúrgicamente / Obstructive jaundice caused by duodenal amyloidosis succesfully treated with surgery

Presentamos un caso clínico de amiloidosis duodenal que se inició como seudotumor (amiloidoma) de localización bulbar, produciendo ictericia obstructiva. Su tratamiento fue quirúrgico, mediante doble derivación biliodigestiva. Esta técnica fue segura y permitió la paliación de la enfermedad con buena calidad de vida

We present a case of obstructive jaundice due to duodenal amyloidosis presenting as a bulbar pseudotumor (amyloidoma). The duodenal and biliary obstruction were treated by double bypass, hepatojejunostomy and gastroenterostomy. Our case suggests that surgical palliative treatment may be effective, and that anastomosis is probably safe, allowing the patient a good quality of life

[Use of pneumoperitoneum in the repair of giant abdominal hernias]. / Neumoperitoneo en el tratamiento de hernias gigantes.

The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years).

Neumoperitoneo en el tratamiento de hernias gigantes / Use of pneumoperitoneum in the repair of giant abdominal hernias

El uso del neumoperitoneo preoperatorio progresivo ha demostrado ser una técnica útil y eficaz para el tratamiento de grandes defectos de la pared abdominal. Está indicado en hernias gigantes, pacientes de alto riesgo quirúrgico y grandes defectos recidivados. Se describe a 4 pacientes en los que se empleó neumoperitoneo progresivo realizado bajo anestesia local y sedación entre 1 y 3 semanas antes de la cirugía, seguido del tratamiento del defecto herniario con malla preperitoneal. Dos pacientes en régimen ambulatorio y 2 hospitalizados. No se detectaron complicaciones postoperatorias. Durante el seguimiento (10 meses-11 años) no hubo evidencias de recidiva (AU)

The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years) (AU)

[Intestinal linitis plastica: late metastasis from gastric signet ring cell adenocarcinoma]. / Linitis plástica intestinal: metástasis tardía de adenocarcinoma gástrico en anillo de sello.

Linitis plastica is a malignant disease that usually occurs in the stomach, although it can affect any segment of the alimentary tract. Typically, this entity shows slow progression and insidious clinical course. We present the case of a patient with a previous diagnosis of signet ring cell cancer of the stomach that had been treated with curative intent 12 years before the clinical onset of small and large bowel linitis plastica. The diagnosis was obtained as an incidental pathological finding after urgent surgery for intestinal obstruction. No gastric mass was found. Linitis plastica should be considered in the differential diagnosis of patients with symptoms of obstruction after resection of a gastric carcinoma, especially if there are macroscopic surgical findings of circumferential narrowing. A long interval after diagnosis and treatment of the primary disease does not allow malignancy to be ruled out.

Linitis plástica intestinal: metástasis tardía de adenocarcinoma gástrico en anillo de sello / Intestinal linitis plastica: late metastasis from gastric signet ring cell adenocarcinoma

La linitis plástica es una entidad maligna típica de tumores gástricos, aunque puede afectar a cualquier segmento del tubo digestivo. Característicamente presenta progresión lenta y clínica insidiosa. Se presenta el caso de un paciente con antecedente de adenocarcinoma gástrico con células en anillo de sello, diagnosticado y tratado con intención curativa 12 años antes del inicio clínico de una linitis plástica de intestino delgado e intestino grueso. El diagnóstico fue obtenido como hallazgo anatomopatológico casual tras cirugía urgente de obstrucción intestinal. No se encontró masa gástrica. La linitis plástica debe ser tenida en cuenta entre los diagnósticos diferenciales, en pacientes intervenidos previamente de neoplasias malignas de estómago que presentan cuadros obstructivos, sobre todo ante hallazgos operatorios macroscópicos de estenosis circunferencial. El largo tiempo de evolución transcurrido desde el diagnóstico y el tratamiento de la enfermedad primaria no permite descartar la naturaleza maligna de la lesión (AU)

Linitis plastica is a malignant disease that usually occurs in the stomach, although it can affect any segment of the alimentary tract. Typically, this entity shows slow progression and insidious clinical course. We present the case of a patient with a previous diagnosis of signet ring cell cancer of the stomach that had been treated with curative intent 12 years before the clinical onset of small and large bowel linitis plastica. The diagnosis was obtained as an incidental pathological finding after urgent surgery for intestinal obstruction. No gastric mass was found. Linitis plastica should be considered in the differential diagnosis of patients with symptoms of obstruction after resection of a gastric carcinoma, especially if there are macroscopic surgical findings of circumferential narrowing. A long interval after diagnosis and treatment of the primary disease does not allow malignancy to be ruled out (AU)