Revisión bibliográfica sobre el tratamiento quirúrgico de la hernia inguinal a propósito de un caso. Actualización de las técnicas laparoscópica preperitoneal transabdominal y totalmente extraperitoneal.

La hernia inguinal, en la actualidad, es una de las patologías más prevalentes en la población. Y aunque se han descrito diversos factores que favorecen su aparición, su etiología sigue siendo una incógnita. Entre sus factores intrínsecos más importantes destacan la edad avanzada, el sexo masculino, el índice de masa corporal bajo y algunas patologías pulmonares, frente a los factores extrínsecos como una baja actividad física. Para poder entender la cirugía reparatoria de la hernia inguinal es imprescindible el estudio de sus diversas estructuras anatómicas, especialmente los músculos abdominales y el conducto inguinal. Existen una gran diversidad de clasificaciones respecto de la hernia inguinal, pero la más aceptada es la clasificación de Gilbert. La cirugía de la hernia inguinal sigue siendo una de las más practicadas en el mundo occidental. A lo largo de la historia ha ido evolucionando con diferentes modalidades técnicas pero siempre con la misma base reparatoria. Y aunque durante muchos años la técnica de Lichstenstein ha sido la técnica quirúrgica más empleada por los cirujanos, hoy en día cada vez se está avanzando más gracias a la cirugía laparoscópica. <br /

No radiographic sacroiliitis progression was observed in patients with early spondyloarthritis at 6 years: results of the Esperanza multicentric prospective cohort

Objective: To estimate the 6-year radiographic progression of sacroiliitis in patients with early spondyloarthritis (SpA). Patients and methods: Sacroiliac joint (SIJ) radiographs (baseline and 6 years) of 94 patients with recent-onset SpA from the Esperanza cohort were scored, blindly and in a random order, by nine readers. The modified New York criteria were used to define the presence of sacroiliitis. As the gold standard for radiographic (r) sacroiliitis, the categorical opinion of at least five readers was used. Progression was defined as the shift from non-radiographic (nr) to r-sacroiliitis. Results: In the 94 SIJ radiographs (baseline and 6 years), 78/94 (83%) pairs of radiographs had not changed from baseline to 6 years. Sacroiliitis was present in 20 patients at baseline (21.3%) and in 18 (19.2%) patients at 6 years; 11 patients had sacroiliitis at both the baseline and final visits; 9 patients changed from baseline r-sacroiliitis to nr-sacroiliitis at 6 years, and 7 changed from baseline nr-sacroiliitis to r-sacroiliitis at 6 years. The mean continuous change score (range: -8 to +8) was 2.80 at baseline and 2.55 at 6 years (mean net progression of -0.25). The reliability of the readers was fair (mean inter-reader kappa of 0.375 (0.146-0.652) and mean agreement of 73.7% (58.7-90%)). Conclusion: In the early SpA Esperanza cohort, progression from nr-axSpA to r-axSpA over 6 years was not observed, although the SIJ radiographs scoring has limitations to detect low levels of radiographic progression

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd