Resultados iniciales de un programa de cirugía tiroidea sin ingreso en un hospital general / Initial results of an outpatient thyroid surgery program in a general

INTRODUCCIÓN: La cirugía ambulatoria se ha consolidado frente a la cirugía con ingreso convencional por razones de tipo económico. Sin embargo, la práctica de tiroidectomías sin ingreso aún no se ha generalizado por considerar que presentan un riesgo postoperatorio demasiado alto. MATERIAL Y MÉTODOS: Análisis descriptivo retrospectivo de las características preoperatorias, las variables intraoperatorias y la evolución postoperatoria de los pacientes propuestos para resección tiroidea en régimen ambulatorio de febrero de 2009 a octubre de 2010.RESULTADOS: Treinta y dos pacientes fueron propuestos para resección tiroidea en régimen ambulatorio. Veintitrés pacientes (72 %) completaron el proceso de cirugía sin ingreso (índice de sustitución: 20,9 %) y 9 pacientes fueron ingresados. La mayoría de procedimientos (91 %) fueron hemitiroidectomías totales o casi totales. El grado de dolor postoperatorio en los pacientes que completaron el proceso de cirugía ambulatoria fue bajo, con una estancia total de 12,3 ± 1 horas. Tres pacientes (13 %) presentaron complicaciones postoperatorias que no requirieron reingreso. Las causas principales de ingreso de los pacientes fueron un procedimiento más extenso del planeado, la sospecha de hematoma o hemorragia y la decisión final del paciente. Ninguno de los pacientes ingresados presentó complicaciones postoperatorias ni requirió tratamiento específico. CONCLUSIONES: La experiencia previa en cirugía ambulatoria y cirugía tiroidea y una cuidadosa monitorización de la seguridad del paciente son básicas para implementar de forma correcta un programa de cirugía tiroidea sin ingreso. Los buenos resultados iniciales permiten plantear un aumento en la complejidad de los procedimientos tiroideos en régimen de CSI

INTRODUCTION: Outpatient surgery has emerged as a valid alternative to conventional inpatient surgery for economic reasons. However, the practice of thyroi-dectomies without admission is not generalized because its postoperative risks are still considered too high.MATERIAL AND METHODS: Retrospective analysis of preoperative characteristics, intraoperative variables and postoperative course of patients proposed for outpatient thyroid resection from February 2009 to October 2010.RESULTS: Thirty-two patients were proposed for outpatient surgery and underwent thyroid resection. Twenty patients (72 %) completed the outpatient process (substitution rate: 20.9 %) and 9 patients were admitted. The majority of procedures (91 %) were total or near-total hemithyroidectomies. Postoperative pain in patients who completed the outpatient process was low, with a total hospital stay of 12.3 ± 1.1 hours. Three patients (13 %) had postoperative complications but did not require readmission. Main admission causes were a more extensive procedure than initially planned, suspicion of hematoma or hemorrhage and patient's final decision. None of the admitted patients had postoperative complications neither required specific treatment.CONCLUSIONS: Previous experience in outpatient and thyroid surgery and a careful patient safety monitoring are essential to correctly implement an outpatient thyroid surgery program. Good initial results enable to increase the procedures' complexity in an outpatient basis

[Diplopia and left palpebral ptosis as a first manifestation of hypophysary metastases of pulmonary adenocarcinoma]. / Diplopía y ptosis palpebral izquierda como primera manifestación de metástasis hipofisarias de adenocarcinoma pulmonar.

A patient, without significant previous medical history, who started with diplopia and left palpebral ptosis as the first manifestation of hypophysary metastases of a widely disseminated and previously undetected cancer of pulmonary origin. Together with a histological study of the lesions, the diagnosis was made with specific image tests of the hypophysary area, which detected a neoformation in the sella turca that was invading the left cavernous sinus with erosion of the verso of the sellar, together with the presence of pulmonary nodules and numerous adenopathies. An hypogonadotropic hypogonadism was detected as the only hormonal alteration due to the infiltration of the anterior hypophysis due to the osseous metastases at the base of the cranium. The patient, in spite of receiving several weeks of radiotherapy, suffered a progressive neurological deterioration and died after a few weeks.