Intraoperative parathyroid hormone measurement vs indocyanine green angiography of parathyroid glands in prediction of early postthyroidectomy hypocalcemia

This study compares the efficacy of intraoperative parathyroid hormone measurement vs indocyanine green angiography of parathyroid glands in predicting early postthyroidectomy hypocalcemia

Duodenopancreatectomía cefálica de urgencia tras una ingesta masiva de cáusticos

La ingesta de sustancias cáusticas es una emergencia que sigue observándose en adultos, principalmente con intención autolítica. Se recomienda un manejo agresivo de estos pacientes, ya que en caso de presentarse hemorragia o sospecha de necrosis y perforación, sólo la cirugía precoz con resección de todas las estructuras lesionadas puede salvar sus vidas. Cuando la..

Indocyanine green angiography-guided thyroidectomy versus conventional thyroidectomy for preserving parathyroid function: study protocol for a randomized single-blind controlled trial

Introduction: Angiography with indocyanine green (ICG) fluorescence performed before thyroidectomy would allow identification of the vascularization of parathyroid glands, maximizing efforts for preserving functioning glands intraoperatively. The rationale of the study was based on the hypothesis that showing the vascular pattern of the parathyroid glands by means of ICG angiography before performing the thyroidectomy could prevent permanent hypoparathyroidism. Methods and analysis: We propose a randomized single-blind controlled and multicenter clinical trial to assess the efficacy and safety of ICG angiography-guided thyroidectomy to identify the vascular pattern of the parathyroid glands versus conventional thyroidectomy in patients scheduled for elective total thyroidectomy. Patients will be randomized 1:1 to ICG angiography-guided thyroidectomy (experimental group) or conventional thyroidectomy (control group). Patients in the experimental group will undergo ICG angiography before thyroidectomy to identify the feeding vessels of the parathyroid glands and then, post-thyroidectomy ICG angiography to predict immediate parathyroid gland function by scoring the degree of fluorescence of the glands. Patients in the control group will undergo post-thyroidectomy ICG angiography only. The primary outcome measure will be the rate of patients with permanent hypoparathyroidism. Secondary outcome measures will be rate of postoperative hypoparathyroidism, the percentage of well vascularized parathyroid glands remaining in situ, the levels of iPTH and serum calcium after surgery and the influence of the type of vascular pattern of the parathyroid glands over these outcomes, as well as the safety profile of ICG angiography. Discussion: The results will contribute to adopt a new surgical strategy based on intraoperative ICG angiography before performing total thyroidectomy, according to which the rate of permanent hypoparathyroidism could be substantially reduced

Results of the management of upper gastrointestinal bleeding from gastroesophageal varices

Introducción: el tratamiento de la hemorragia digestiva alta por rotura de varices esofágicas y/o gástricas en pacientes con cirrosis hepática debe estar dirigido al control inicial de la hemorragia sin alterar más una función hepática ya deteriorada , y a la prevención de la recidiva hemorrágica precoz. Métodos endoscópicos, farmacológicos y quirúrgicos forman el conjunto de alternativas terapéuticas. Material y métodos: estudio prospectivo de los resultados obtenidos tras el seguimiento de 90 episodios hemorrágicos de un total de 54 pacientes, 35 hombres y 19 mujeres, con una edad media de 58 años (32-77), sobre los que se aplicó un protocolo terapéutico de la hemorragia aguda secundaria a la hipertensión portal, durante un periodo de 22 meses. La clasificación según Child-Pugh al ingreso fue 57% Child A, 34% Child B y 9% Child C. Resultados: la estancia media hospitalaria fue de 9 días (2-50). De los 90 episodios hemorrágicos, se registraron 15 recidivas hemorrágicas precoces (16,7%). Murieron 12 pacientes (mortalidad del 22,2% por pacientes y del 13,4% por episodios hemorrágicos). Se realizaron 12 intervenciones de urgencias por persistencia de la hemorragia. El 41% de los pacientes reingresaron por recidiva de la hemorragia al menos una vez durante el periodo de seguimiento. Conclusiones: el tratamiento de la hemorragia digestiva alta por varices esófago-gástricas con cirrosis hepática, requiere un conjunto de diferentes tratamientos para obtener la máxima eficacia en el episodio hemorrágico agudo y poder abarcar todas las posibles repercusiones a posteriori; dicho tratamiento debería ser realizado en un centro hospitalario que disponga de material y personal especializado en esta patología. En nuestra experiencia, la cirugía de urgencias, como tratamiento de rescate de la hemorragia persistente o recidivante a corto plazo, sólo tendría lugar en algunos pacientes con una buena función hepática dada su alta morbi/mortalida

Improved crack resistance and thermal conductivity of cubic zirconia containing graphene nanoplatelets

Composites of 8 mol.% yttria-stabilized zirconia (8YSZ) with graphene nanoplatelets (GNP) have been pointed as alternative interconnectors in SOFC due to their mixed ionic-electronic conduction. Here we show that GNP addition provides rising crack-resistance behavior, with long crack toughness up to 78% higher than that of 8YSZ, also improving its thermal conductivity (up to 6 times for the in-plane direction). Toughness versus crack length is measured for 7 and 11 vol.% of GNP using single edge V-notched beam technique and ultrashort pulsed laser notching; and thermal behavior is analyzed by the laser flash method. Materials also have highly anisotropic coefficient of thermal expansion. These properties contribute to enhance their performance under the harsh operating conditions of SOFC, as thermal residual stresses could be reduced while significantly improving the system mechanical stability. Moreover, the heat transfer may be enhanced especially along the interface direction which would increase the system efficiency.This work was supported by Spanish project RTI2018-095052-B-I00, Ministerio de Ciencia, Innovacion y Universidades, Spain (MCIU/AEI/FEDER, UE). AG and PM acknowledge support from Ministerio de Economía, Industria y Competitividad, Spanish government (Project FIS2017- 87970-R) and Junta de Castilla y León, Spain (Project SA287P18). C. R. thanks the financial support by MCIU under contract IJCI-2017-34724 of “Juan de la Cierva” Program

Morphological alterations in dentine after mechanical treatment and ultrashort pulse laser irradiation

The aim of this study was to evaluate and compare the morphological changes that occur in dentine after femtosecond laser irradiation and after mechanical treatment. The duration of the laser pulse is an important parameter, because within the time frame of the pulse heat diffusion plays a very important role in the mechanism of interaction between the light and the tissue. Six totally impacted human third molars were sectioned into sheets approximately 1 mm thick with an Accutom-50 precision cutting machine. The samples were randomly divided into two groups according to their cavity preparation: mechanical cavity preparation and laser cavity preparation. The samples were then examined by light microscopy and scanning electron microscopy. There were clear differences in the results obtained with the two techniques. Cavities prepared with the laser with pulses of <1 ps showed no microcracks, and the treated surface displayed a rough and irregular aspect with no smear layer and exhibited open dentinal tubules. On the contrary, cavities made with a rotatory instrument had a smooth surface and microcracks, a broad area of carbonization and merging, occluded dentinal tubules and a smear layer. This study showed that human dentine can be successfully ablated with the ultrashort pulse laser.A.G. and P.M. acknowledge the support of Spanish Ministerio de Ciencia e Innovación through the Consolider Program SAUUL (CSD2007-00013) and research project FIS2009-09522, from Junta de Castilla y León through the Program for Groups of Excellence (GR27) and of the EC Seventh Framework Programme (LASERLAB-EUROPE, grant agreement no. 228334). We also acknowledge the support of the Centro de Laseres Pulsados, CLPU, Salamanca, Spain

Intraoperative indocyanine green (ICG) angiography of the parathyroids glands in prediction of post-thyroidectomy hypocalcemia: Diagnostic accuracy of the ICG score 2 versus the 4-ICG score

Introducción: la angiografía de las glándulas paratiroides con verde de indocianina (ICG) es útil para predecir la hipocalcemia postiroidectomía. En este estudio se ha comparado la exactitud diagnóstica del sistema ICG-2, basado en la presencia de glándulas bien perfundidas (puntuación igual a 2), con el sistema ICG-4 basado en la suma del valor de la puntuación de las 4 glándulas. Métodos: un total de 50 pacientes (66% mujeres, mediana de edad: 49,4 años) fueron operadas practicándose una tiroidectomía total con identificación de las 4 glándulas paratiroides. El grado de la ICG se clasificó como 0: color negro (no vascularizada), 1: color gris/heterogéneo (parcialmente vascularizada) y 2: color blanco (bien vascularizada). Resultados: la exactitud diagnóstica de ICG-4 para un punto de corte ≤ 3 fue del 85% (intervalo de confianza del 95%: 70,9-92,8), inferior al 92% (80,8-97,8) del ICG-2. Con ambas puntuaciones se detectaron 2 casos de falsos negativos, pero las tasas de falsos positivos fueron menores con el ICG-2 (18,2 vs. 57,1%). Conclusiones: el sistema ICG-2 predice la función paratiroidea en el postoperatorio inmediato mejor que el ICG-4 para valores de punto de corte ≤ 2 y ≤ 3

Laparoscopy versus open adrenalectomy in patients with solid tumor metastases: results of a multicenter European study

Background: The outcome of adrenalectomy carried out by laparoscopy or open surgery for solid tumor metastases was assessed. Methods: A total of 317 patients with histologically confirmed adrenal metastatic disease collected from 30 centres in Europe underwent adrenalectomy by laparoscopy (n=146) or open laparotomy (n=171). Differences between laparoscopic and open adrenalectomy were assessed by a single Cox analysis for both procedures. Results: The median overall survival was 24.0 [95% confidence interval (CI): 21.4-26.6] months for open adrenalectomy and 45.0 (95% CI: 22.6-67.4) for laparoscopic adrenalectomy (P=0.008). Survival rates were 68%, 49%, 35% and 29% at 1, 2, 3 and 5 years for open surgery vs. 88%, 62%, 52% and 46% for laparoscopy, respectively. In the subgroup of R0 resections, the difference in survival in favor of laparoscopy (median 46 vs. 27 months) was marginally significant (P=0.073). Renal cancer [hazard ratio (HR) 0.42; 95% CI: 0.23-0.76, P=0.005], surgery of the primary tumor (HR 0.33; 95% CI: 0.19-0.54), and use of chemotherapy (HR 0.62; 95% CI: 0.43-0.88) were associated with a better survival, whereas type of resection (R1/R2 vs. R0) was associated with a worse prognosis (HR 2.29; 95% CI: 1.52-3.44, P<0.001). Conclusions: Laparoscopic adrenalectomy patients showed a longer survival than open adrenalectomy individuals, as minimally invasive approach was attempted more common in less advanced disease which led to higher number of R0 resections

Tratamiento quirúrgico de la patologia urgente del colon izquierdo

El objetivo de este estudio es evaluar la morbilidad y mortalidad postoperatoria tras la aplicación de un protocolo terapéutico en los pacientes intervenidos de urgencia por patología del colon izquierdo. Como primera opción se practicó el Lavado Anterogrado Peroperatorio en todas las lesiones del colon izquierdo que precisaron intervención urgente. En lesiones irresecables, peritonitis fecaloidea, deterioro del estado general o lesiones asociadas en el resto del colon. se aplicaron otras opciones: la colostomía de descarga, la operación de Hartmann o la colectomía subtotal. Se practicaron 127 resecciones urgentes del colon izquierdo. En 56 casos se optó por la operación de Hartmann. en 38 por la colectomía subtotal y en 33 por el lAP. La complicación más frecuente fue la sepsis abdominal (29%). La mortalidad operatoria global fue del 24%. 390Ai para la operación de Hartmann. 16% para la colectomía subtotal y 6% para el LAP. El LAP es la intervención de elección en aquellos pacientes con buen estado general que presentan patología urgente del colon izquierdo sin peritonitis fecaloidea. ni lesión irreversible del colon derecho