David Esmer-Sánchez

Eficacia de la auriculoterapia modificada como tratamiento para el control del dolor postoperatorio en pacientes intervenidos mediante colecistectomía laparoscópica

BACKGROUND The high frequency of post-operative pain in the patients after laparoscopic cholecystectomy has led to the need to use multiple analgesic therapies. These include auriculotherapy, although not very good results have been obtained with the traditional techniques. OBJECTIVE To evaluate the effectiveness of modified auriculotherapy for post-operative pain control in laparoscopic cholecystectomy patients. MATERIAL AND METHODS Double-blind controlled clinical trial. Experimental group: Different points ear puncture with xylocaine without needles vs. placebo group. Post-operative visual analogue scale (VAS) at 6, 12, 18, 24, 36, and 48h and rescue doses of analgesics, were measured in both groups. RESULTS At 6h post-operative, 87% of the auriculotherapy group had a VAS of<4 vs. 48% of placebo group (p = 0.004), and 96 vs. 74% (p = 0.008) at 18hours. At 24, 36 and 48h after surgery there were no differences, and as all of the patients in both groups had a VAS<4, they were discharged to the hospital. CONCLUSIONS Modified auriculotherapy was better to the conventional analgesics for post-operative pain control in patients subjected to laparoscopic cholecystectomy.

Diagnóstico de adenocarcinoma mucinoso (coloide) pulmonar por cirugía torácica asistida por video. Reporte de caso

BACKGROUND Mucinous colloid lung adenocarcinoma is an uncommon variant of lung carcinomas with similar features to tumours seen in the gastrointestinal tract. To distinguish between these tumours and other mucinous lung tumours, such as mucinous bronchioloalveolar cell carcinomas and metastatic mucinous lesions could be difficult with small biopsy specimens from fine needle aspiration. CLINICAL CASE The case is described of a 49-year-old female with history of dyspnoea and cough with bloody sputum and weight lose. Thorax axial computed tomography demonstrated a right lower lobe spiculated mass with calcifications. Transthoracic computed tomography- guided fine needle biopsy reported negative results, and the biopsy obtained with video-assisted thoracic surgery was useful for an adequate cytology report of a colloid variant of mucinous lung adenocarcinoma. CONCLUSION Video-assisted thoracic surgery is an appropriate option for obtaining a larger specimen in those cases where small biopsies are inconclusive for the diagnosis of thoracic pathologies such as malignant tumours.