Sarcoma indiferenciado pleomórfico en dermis perianal: una extraña localización.

Presentamos el caso de una mujer de 84 años con antecedentes personales de HTA, dislipemia, DM2, hipotiroidismo autoinmune en tratamiento sustitutivo y leucoencefalopatía isquémica crónica .Se realizó una colonoscopia  previa en 2018 en el contexto de estudio de anemia, donde sólo se apreció un engrosamiento de válvula ileocecal, obteniendo resultados  anatomo-patológicos  de inflamación crónica inespecífica. Sin intervenciones quirúrgicas abdominales. La paciente es derivada por su MAP a consultas externas de cirugía por presentar dolor y tumoración perianal de dos meses de evolución, con supuración intermitente las últimas semanas, a pesar de tratamiento antibiótico oral. Además, febrícula ocasional y proctalgia desde el comienzo de la supuración. Es valorada en consultas de cirugía con diagnóstico de absceso perianal e induración periabsceso, por lo que se envía a urgencias para realizar drenaje y exploración bajo anestesia de la lesión

Sarcoma indiferenciado pleomórfico en dermis perianal: una extraña localización.

Presentamos el caso de una mujer de 84 años con antecedentes personales de HTA, dislipemia, DM2, hipotiroidismo autoinmune en tratamiento sustitutivo y leucoencefalopatía isquémica crónica .Se realizó una colonoscopia  previa en 2018 en el contexto de estudio de anemia, donde sólo se apreció un engrosamiento de válvula ileocecal, obteniendo resultados  anatomo-patológicos  de inflamación crónica inespecífica. Sin intervenciones quirúrgicas abdominales. La paciente es derivada por su MAP a consultas externas de cirugía por presentar dolor y tumoración perianal de dos meses de evolución, con supuración intermitente las últimas semanas, a pesar de tratamiento antibiótico oral. Además, febrícula ocasional y proctalgia desde el comienzo de la supuración. Es valorada en consultas de cirugía con diagnóstico de absceso perianal e induración periabsceso, por lo que se envía a urgencias para realizar drenaje y exploración bajo anestesia de la lesión

SARS-CoV-2 vaccination modelling for safe surgery to save lives: Data from an international prospective cohort study

Background: 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

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies