Reacción anafilactoide a látex tras colocación de malla transvaginal para corrección de cistocele / Anaphylactoid latex reaction after transvaginal mesh placement for cystocele correction

La incidencia de alergia al látex en la población general es del 1-2%, siendo las reacciones más frecuentemente descritas de hipersensibilidad inmediata o tipo i y tardía o tipo iv, aunque también han sido descritas reacciones de hipersensibilidad no mediadas por IgE.Presentamos el caso de una mujer de 71 años con factores de riesgo cardiovascular (HTA y DLP) e intervenida previamente de colecistectomía y cistocele que ingresa de forma programada para intervención de recidiva de cistocele grado iv tras 4 años de la primera intervención.En el postoperatorio inmediato presenta fracaso renal agudo, por lo que se retira la malla a las 24h, persistiendo deterioro progresivo del estado general con dificultad respiratoria, disminución del nivel de conciencia y empeoramiento de la función renal. Tras una exploración exhaustiva se visualiza eritema en región vulvar e inguinal, por lo que se sospecha reacción anafiláctica a sonda de látex, que se recambia por una sonda de silicona, iniciándose tratamiento con metilprednisolona intravenosa y se consulta con el servicio de Alergología, que establece finalmente el diagnóstico.La paciente requirió ingreso en la unidad de cuidados intensivos durante 10 días por insuficiencia renal aguda e insuficiencia respiratoria aguda asociadas a íleo paralítico y coagulopatía.La anafilaxia es una reacción sistémica aguda que resulta en la liberación brusca de mediadores de los mastocitos y basófilos, mediada o no por IgE. Se admite que es una reacción de hipersensibilidad sistémica grave, de inicio repentino y potencialmente mortal. Clínicamente se asocia a la aparición de manifestaciones cutáneas relacionadas con alteraciones cardiovasculares, respiratorias o gastrointestinales.

Allergy to latex in the general population is 1-2%, the most frequent reactions described being immediate or type i and late or type iv hypersensitivity, although non-IgE-mediated hypersensitivity reactions have also been described.We present the case of a 71-year-old woman with cardiovascular risk factors (HTN and PLD) and previously operated on for cholecystectomy and cystocele who was admitted on a scheduled basis for intervention for grade iv cystocele recurrence, 4 years after the first intervention.In the immediate postoperative period, she presented acute renal failure, for which the mesh was removed after 24h, her general condition progressively deteriorated with respiratory distress, decreased level of consciousness, and worsening of renal function. After an exhaustive examination, erythema was visualized in the vulvar and inguinal region, hence the suspicion of an anaphylactic reaction to a latex catheter, which was replaced by a silicone catheter. Treatment was started with intravenous methylprednisolone, and the Allergology service was consulted who finally established the diagnosis.The patient required admission to the intensive care unit for 10 days due to acute renal failure and acute respiratory failure, associated with paralytic ileus and coagulopathy.Anaphylaxis is an acute systemic reaction that results in the abrupt release of mediators from mast cells and basophils, mediated or not by IgE. It is recognized to be a severe, sudden onset, and life-threatening systemic hypersensitivity reaction. Clinically, it is associated with the appearance of skin manifestations related to cardiovascular, respiratory, or gastrointestinal disorders.

Cirugía de puerto único transumbilical con instrumentos laparoscópicos convencionales en riñón en herradura / Transumbilical Single Port Surgery With Conventional Laparoscopic Instruments in Horseshoe Kidney

Introducción: La cirugía laparoscópica está teniendo una evolución natural a disminuir la agresión quirúrgica sobre la pared abdominal, sin merma de los resultados curativos y funcionales. Aunque en desarrollo, la cirugía monopuerto ha supuesto un avance en este sentido. Material y métodos: Presentamos la primera cirugía de pielolitectomía laparoscópica por puerto único en riñón en herradura, usando instrumentos rígidos convencionales. Paciente de 18 años con IMC de 19 que en las pruebas de imagen (urograma y tomografía computarizada) presenta un riñón en herradura con litiasis coraliforme izquierda y discreta ectasia calicial. Se extrae la litiasis mediante acceso umbilical con artilugio monopuerto e instrumentos rígidos convencionales. Resultados: La cirugía se completó sin complicaciones. El tiempo quirúrgico fue 110 min y el sangrado 50 cc. Al abrir el sistema urinario hubo extravasación de orina purulenta que condicionó fiebre en el postoperatorio de 38 ◦C. Durante la intervención se colocó catéter doble J por abordaje percutáneo. Fue dada de alta al tercer día de estancia. Conclusión: El acceso laparoscópico monopuerto para la cirugía de pielolitectomía en un riñón en herradura es una alternativa razonable. El uso de instrumentos convencionales rígidos facilita el desarrollo de esta cirugía con una buena triangulación, sin conflicto de manos y seguridad para el paciente (AU)

Introduction: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. Material and methods: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. Results: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 ◦C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. Conclusion: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney isa reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient (AU)

Transumbilical single port surgery with conventional laparoscopic instruments in horseshoe kidney.

INTRODUCTION: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.

Actualización del trabajo excéntrico de cuádriceps en pacientes en edad laboral con tendinopatía rotuliana / Eccentric training programs for infrapatellar tendinopathy: new strategies for an old problem

La tendinopatía rotuliana, como enfermedad ocupacional es un proceso de cierta relevancia en paises de nuestro entorno que precisa no solo profundizar en su sustrato anatomo-patológico sino también en estrategias terapéuticas, preferentemente de tipo conservador. Y entre estas últimas, la realización de un programa de entrenamiento excéntrico de cuádriceps sobre plataforma inclinada de 30º podría ser de gran interés. En nuestro estudio participaron 46 adultos varones en edad laboral con un diagnóstico clínico de tendinopatía rotuliana confirmado por ecografía. Como parámetros de estudio se ha recurrido tanto a variables subjetivas (Escala Visual Analógica de 100 mm) como objetivas (pruebas de imagen [ecografía] y recuperación de la actividad profesional habitual) Aunque condicionados por lo limitado del tamaño muestral, nuestros resultados nos permiten concluir con la recomendación de realizar ejercicios excéntricos (sentadillas) sobre una plataforma inclinada de 30º. Futuros estudios en esta línea de trabajo son necesarios

Paralell with the improved knowledge on the pathophysiology of patellar tendinopathy, new treatment strategies are expected to emerge. 46 male adults clinically diagnosed and imaging confirmed patellar tendinopathy underwent a conservative treatment based on cryotherapy, isometric and eccentric exercises as well as stretching. They were randomly divided into group A (Standard squat program; n=23) and B (30º decline eccentric program; n=23). Eccentric program consisted of 3 sets of 15 repetitions twice a day for 16 weeks. Patients were instructed to perform it with the trunk upright, by slowly flexing the knee to 90º of flexion and returning to starting position using the non-injuried leg. Subjetives (100 mm Visual Analogue Scale [VAS]) and objectives (ultrasonography and return to pre-injury activity) variables were evaluated. We may conclude conservative treatment based on decline eccentric program showed better results than standard squat program. However, since the number of participants was low, these data should be interpreted with caution