9 research outputs found
Obstrucción intestinal y hernia interna tras by-pass gástrico laparoscópico
No full textThe postoperative intestinal obstruction syndrome is a known complication of bariatric surgery and has different etiologies: bridles, volvulus, stenosis or internal hernias. We present the clinical case of a 61-year-old patient who underwent gastric bypass retrocolic ringed and laparoscopic cholecystectomy due to obesity who suffers internal hernia through a mesenteric orifice with irreversible intestinal ischemia, which requires disassembly of the bypass with intestinal resection, including a food loop and foot. of the loop, partial gastrectomy and urgent splenectomy. We proceed to reconstruction of the transit with gastro-gastric end-lateral and latero-lateral jejunojejunal anastomosis. In patients undergoing laparoscopic bariatric surgery, it is important to consider intestinal obstruction due to internal hernia as a serious, relatively frequent and potentially fatal complication.El síndrome de obstrucción intestinal postoperatoria es una complicación conocida de la cirugía bariátrica y tiene diferentes etiologías: bridas, vólvulos, estenosis o hernias internas. Presentamos el caso clínico de una paciente de 61 años intervenida de bypass gástrico retro cólico anillado y colecistectomía laparoscópicos por obesidad que sufre hernia interna a través de orificio mesentérico con isquemia intestinal irreversible que obliga a desmontaje del bypass con resección intestinal, incluyendo asa alimentaria y pie de asa, gastrectomía parcial y esplenectomía urgente. Se procede a reconstrucción del tránsito con anastomosis gastro-gástrica T-L y yeyunoyeyunal L-L. En pacientes intervenidos de cirugía bariátrica laparoscópica es importante tener en cuenta la obstrucción intestinal por hernia interna como complicación grave, relativamente frecuente y potencialmente mortal
Migración de funduplicatura gástrica con perforación intratorácica
No full textThe laparoscopic antireflux surgery is considered the gold standard for the treatment of gastroesophageal reflux disease and hiatal hernia. The postoperative results show a low associated morbidity and mortality and good satisfaction in the medium long term.
We present the clinical case of a 53-year-old patient who underwent Nissen-Rossetti laparoscopic fundoplication who, on the twelfth postoperative day, presented with mediastinitis associated with sepsis due to intrathoracic perforation of the gastric fundoplication migrated to the chest. The patient was operated on urgently, performing thoracic drainage, supra-umbilical median laparotomy and primary closure of the perforation. The postoperative period is characterized by a 23-day stay in the intensive care unit and by necrotizing pneumonia, lung abscesses, and left pleural empyema. Ten years after the episode, the patient is asymptomatic and has no signs of clinical recurrence.
Although the incidence of early complications in antireflux surgery is relatively low, it is mandatory to suspect them in a patient with sepsis due to mediastinitis and recent surgery. In front of extremely serious situations, it is necessary to intervene urgently, although the surgical re-exploration of the hiatus is considered a complex surgery with a high risk of iatrogenesis.La cirugía antirreflujo mediante abordaje laparoscópico se considera el gold estándar para el tratamiento de la enfermedad por reflujo gastroesofágico y de la hernia de hiato. Los resultados postoperatorios presentan una morbimortalidad asociada baja y una buena satisfacción en el medio largo plazo.
Presentamos el caso clínico de un paciente de 53 años intervenido de funduplicatura laparoscópica tipo Nissen-Rossetti que en el duodécimo día postoperatorio presenta clínica de mediastinitis asociada a sepsis por perforación intratorácica de la funduplicatura gástrica migrada a tórax. El paciente es intervenido de forma urgente, realizándose drenaje torácico, laparotomía media supra-umbilical y cierre primaria de la perforación. El postoperatorio se caracteriza por una estancia de 23 días en la unidad de cuidados intensivos y por neumonía necrotizante, abscesos pulmonares y empiema pleural izquierdo. A 10 años del episodio, el paciente se encuentra asintomático y sin signos de recidiva clínica.
Aunque la incidencia de las complicaciones tempranas en la cirugía antirreflujo es relativamente baja, es obligatorio sospechar de ellas en un paciente con sepsis por mediastinitis y cirugía reciente. Antes situaciones de extrema gravedad es necesario intervenir de forma urgente aunque la re-exploración quirúrgica del hiato es considerada una cirugía compleja y de elevado riesgo de iatrogenia
Artes de canto (1492-1626) y mujeres en la cultura musical del mundo ibérico renacentista
No full text[spa] Esta Tesis Doctoral explora la cultura musical del mundo ibérico renacentista a través del estudio de artes de canto en lengua vernácula impresas entre 1492 y 1626 y de su relación con las mujeres de la época. La Tesis consta de siete capítulos, estructurados en dos partes (Vol. I), y de veinte apéndices (Vol. II). La primera parte (Capítulos I al IV) muestra que las características por las que estos libros que contenían los rudimentos de la música han sido infravalorados hasta ahora por la historiografía musical son precisamente las mismas que demuestran que respondían a una necesidad pedagógica y a la demanda de manuales asequibles, breves y prácticos por parte de un amplio mercado. Las artes de canto se imprimieron en tiradas de miles de ejemplares y eran vendidas a bajo precio, tuvieron una enorme circulación en la Península Ibérica y el Nuevo Mundo, y contribuyeron al incremento y la difusión de la educación musical en contextos educativos diferenciados (la iglesia, la universidad y el ámbito privado), así como entre grupos sociales hasta entonces excluidos del aprendizaje de los fundamentos de la música. El Arte de canto llano (Sevilla, 1530) de Juan Martínez emerge como el tratado de música del mundo hispánico más difundido geográfica y cronológicamente en el siglo XVI e inicios del XVII, pero del que casi nada se sabía. En la segunda parte (Capítulos V al VII), las conexiones entre estos libros de música y mujeres muestran que las áreas de superposición entre lo privado y lo público y entre lo oral y lo escrito permiten desafiar la invisibilidad de las mujeres en documentos históricos y vislumbrar trazas no sólo de la cultura musical de las mujeres de la época, sino también de la importancia de la música en la vida cotidiana. Se utiliza una diversidad de fuentes (artes de canto, libros de conducta, documentos inquisitoriales, literatura, correspondencia e inventarios de bienes, entre otras), a través de las cuales se ha podido documentar la relación con la música de, entre otras, Catalina de Zúñiga, VI Condesa de Lemos, Isabel de Plazaola, e Isabel de Aragón, IV Duquesa del Infantado. Empleando metodologías de la musicología tradicional junto a otras tomadas de los historiadores del libro y de la cultura popular, esta Tesis Doctoral presenta una panorámica de la vida musical de la época a través del prisma de doble alteridad que supone el estudio de las artes de canto, generalmente consideradas carentes de interés, y de su relación con las mujeres, insuficientemente representadas en la historiografía musical.[eng] This dissertation explores the musical culture of the Renaissance Iberian world through both the study of small-format treatises in the vernacular containing the rudiments of music –known as artes de canto– printed between 1492 and 1626, and the nexuses between them and women. The dissertation consists of seven chapters, structured into two parts (Volume I), and twenty appendixes (Volume II). Part I (Chapters I to IV) shows that the arte de canto, until now generally overlooked or undervalued in music historiography, was produced in print runs of thousands of copies and sold for a low price; it had a broad circulation in the Iberian Peninsula and the New World, contributing to the spread of musical literacy in distinct didactic contexts (churches, universities, private settings) and among social groups until then excluded from learning the rudiments of music. The little known Juan Martínez’s Arte de canto llano (Seville, 1530) emerges as the most circulated music book in the Hispanic world during the sixteenth and seventeenth centuries. The aim of Part II (Chapters V to VII) is to approach the musical life of the sixteenth-century Iberian world through the exploration of women’s contributions, thus broadening the field of historical research. The study of some connections between music books and women shows that the points of overlap between the private and the public spheres, on the one hand, and the written and the oral music transmission, on the other hand, not only make women’s musical practices visible, but also offer new vistas on the popular culture of the age. Through a variety of source materials (artes de canto, conduct manuals, Inquisition records, literature, letters and inventories of goods, among others) it has been possible to document the musical activities of women such as Catalina de Zúñiga, VI Countess of Lemos, Isabel de Plazaola, and Isabel de Aragón, IV Duchess of the Infantado. Combining methodologies from traditional musicology with those borrowed from book history and popular culture, this dissertation analyzes music in the culture of the Renaissance Iberian world through the prism of double Otherness involved in studying the ‘other’ music books –that is the undervalued artes de canto– and their connections to women of that period
Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey
No full text: The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results
Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey
No full textPredictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study
No full textBackground
In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery.
Methods
An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis.
Results
The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”.
Conclusions
The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
No full textBackground: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population
