Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos

To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery

Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura

Objective: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. Material and methods: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. Results: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II). Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). Conclusions: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve

Association of crossed renal ectopia and aortic aneurism. Case report

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen

Respuesta y supervivencia libre de progresión en tumores vesicales en estadiosT2-T4 tratados con tratamiento trimodal de conservación vesical

Objective: Toevaluatetheresponseandthefree-survivalprogressioninpacientsdiagnosed of invasivebladdercancerwhohavebeentreatedwithtransurethralresection, chemotherapyandradiotherapy.Thismultimodaltreatmentiscomparedwithanot random serieofpatientstreatedbyradicalcistectomy. Material andmethods: Retrospectiveanalysisof43casesofinvasivebladdercancertreated with twoschemesofbladderpreservationbetween1994–2007.Theyarecomparedwith145 cases treatedwithradicalcistectomyinthesameperiodoftime. Pronosticvariablesincludedinthestudyareclinicalstage,gradeofdifferentiation, presence ofureteralobstruction,chemotherapymodality,radiotherapydosesandp53and ki-67 expression. Results: Meanandmediantimeare51and39monthsinpatientswithmultimodal treatment.Completeresponseisachievedin72%ofcasestreatedwithbladder preservation.Ureteralobstructionisaprognosticfactor(OR:7,3;p:0,02).72%patientswith complete responsemantainitattheendofthestudy.Noneofanalyzedvariablesare predictors ofmaintenanceoftheresponse. Survivalrateswithaintactbladderwere6977% and6177% atthreeandfiveyears. Radiotherapydosesgreaterthan60Gy(OR:6,1;po0,001) andtheabsenceofureteral obstruction (OR:7,5;po0,002) werepronosticvariables. Free-survivalinpatientswithcompleteresponsewas8077% and58710% atthreeand five years. At theendofthestudy,53,5%ofpatientshadaintactbladderandfree-disease. Inthesameperiodoftime,145radicalcistectomieswereperformedduetomuscleinvasive bladdercancer.Meanandmediantimeinthisgroupwere29and18monthsrespectively. Stadisticalanalysisrevealsaworseclinicalstageinthegroupofpatientstreatedwith multimodaltreatment(p:0.01). Free-survivalwas7275% and6377%at3and5yearsinthegroupofradical cistectomies.Therewasnotstadisticalsignificantdifferencesbetweencistectomiesand bladderpreservation. Conclusions: Patientstreatedwithbladderpreservationhaveafree-survivalsimilartothose tretedwithradicalcistectomy.Radiotherapy doses greaterthan60Gyandabsenceofureteral obstructionwerefree-survivalprognosticvariables

Impact of renal retransplantation on graft and recipient survival

The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival. METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival. A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests. RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45 (10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (+/-54.1 SD). There were no differences in follow-up between groups (Mean Follow-up 73.1 months +/-54.4 SD in first transplantations vs. 61.6 months +/-51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 89% (95% CI: 87-91%) and 84%(95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI:i; 80-90%) respectively]. After adjusting for all the heterogeneity variables we still did not find differences on graft survival. The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs.97%]. CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graf tsurvival. Results: At least one surgical complication occurred in 82(38%)of the 216 transplantations, and 68(31%)required some type of repeat surgery,23 in the early post operative period and 45 more than 3 months after surgery. Mean follow–up was 48 months(SD þ/ 33.4), and median follow–up 48 months(range,0–166months). No recipient or donor factor spredisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3-and 5-year survival rates of 86%(95%CI83%–89%)and 78%(95%CI73%–82%)as compared to 92% (95%CI90%–94%)and 88%(95%CI85%–91%),p:0.004].Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole groups howed early repeat surgery to bea factor with an independent prognostic value (OR:4.7;95%CI2.2–10,po0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival.Then eed for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival

Factores influyentes en el tiempo hasta la progresión bioquímica después de prostatectomía radical

INTRODUCTION: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. MATERIALS AND METHODS: Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages. RESULTS: With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p=0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p=0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p=0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen ( 10%) (p=0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p=0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p=0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p=0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. CONCLUSION: The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors

Characteristics of emergency medicine residency programs in Colombia

Introduction: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. Results: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs. © 2017 Patiño et al

Characteristics of Emergency Medicine Residency Programs in Colombia

Introduction: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013–2016. Topics included program characteristics and curricula. Results: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3–10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2–15. EM rotation requirements range from 11–33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1–2 months of pediatrics or pediatric EM. Critical care requirements range from 4–7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4–6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs