Francisco Miguel González Valverde

Mejora de la calidad en el consentimiento informado

Aim: To apply an enhancement circle for informed consent for transfusion of blood derivatives. Patients and Method: During 10 months 577 intervened patients were included in General Hospital Reina Sofia of Murcia, Spain. Six criteria were selected related to compliance with transfusion norms. After quality analysis, corrected measures were taken and the criteria were re evaluated. Data were compared with standards in both periods and between periods. In the first evaluation a poor compliance to criteria was observed. Based on the analysis of factors associated to lack of compliance and the resulting priorization from Pareto’s diagram, the intervention plan was divided in teaching activity and management modifications. Results: all criteria were under the standard (p<0.001). In the second evaluation, compliance for all criteria was significantly enhance with respect to the first; but nevertheless, results continue, also significantly, under established standards. Conclusions: Compliance to the six criteria was minimum at the beginning of the study; corrected measures were adequate, since they enhance all of them in the second evaluation, but it is necessary to insist in these measures since we continue under the established standard.Aim: To apply an enhancement circle for informed consent for transfusion of blood derivatives. Patients and Me- thod: During 10 months 577 intervened patients were included in General Hospital Reina Sofia of Murcia, Spain. Six criteria were selected related to compliance with transfusion norms. After quality analysis, corrected measures were taken and the criteria were re evaluated. Data were compared with standards in both periods and between periods. In the first evaluation a poor compliance to criteria was observed. Based on the analysis of factors associated to lack of compliance and the resulting priorization from Paretos diagram, the intervention plan was divided in teaching activity and management modifications. Results: all criteria were under the standard (p<0.001). In the second evaluation, compliance for all criteria was significantly enhance with respect to the first; but nevertheless, results continue, also significantly, under established standards. Conclu - sions: Compliance to the six criteria was minimum at the beginning of the study; corrected measures were adequate, since they enhance all of them in the second evaluation, but it is necessary to insist in these measures since we continue under the established standard.

Fatal Heat Stroke in a Schizophrenic Patient

Objective. The case of a patient who developed a fatal post-exertional heat stroke is reported. Case Report. A 20-year-old man with a history of morbid obesity, hypertension, and schizophrenia was admitted to our intensive care unit because of multiorgan failure due to severe heat stroke. He had been working under the sun. Treatment included aggressive body cooling but, in spite of the best supportive care, the patient succumbed in a few hours. We concluded that the adverse event was possibly associated with his obesity and the use of antipsychotics. Histological evaluation revealed lesions consistent with severe hyperthermia and shock. Conclusions. Heat stroke is an uncommon clinical entity characterized by systemic heat and loss of the bodys normal mechanisms for dealing with heat stress, such as sweating and temperature control. When heat stroke is diagnosed early and supportive care begins promptly the prognosis is optimal but it becomes a life-threatening disease when treatment is delayed. Lack of physical acclimatization and the use of certain medications that interfere with salt and water balance can impair thermoregulation under conditions of high environmental temperature. Health professionals must be adequately prepared to prevent, recognise, and treat them urgently.Objective. The case of a patient who developed a fatal post-exertional heat stroke is reported. Case Report. A 20-year-old man with a history of morbid obesity, hypertension, and schizophrenia was admitted to our intensive care unit because of multiorgan failure due to severe heat stroke. He had been working under the sun. Treatment included aggressive body cooling but, in spite of the best supportive care, the patient succumbed in a few hours. We concluded that the adverse event was possibly associated with his obesity and the use of antipsychotics. Histological evaluation revealed lesions consistent with severe hyperthermia and shock. Conclusions. Heat stroke is an uncommon clinical entity characterized by systemic heat and loss of the bodys normal mechanisms for dealing with heat stress, such as sweating and temperature control. When heat stroke is diagnosed early and supportive care begins promptly the prognosis is optimal but it becomes a life-threatening disease when treatment is delayed. Lack of physical acclimatization and the use of certain medications that interfere with salt and water balance can impair thermoregulation under conditions of high environmental temperature. Health professionals must be adequately prepared to prevent, recognise, and treat them urgently.

Laparoscopic adrenalectomy for nonfamilial adrenal medullary hyperplasia.

BACKGROUND AND OBJECTIVES Sporadic adrenomedullary hyperplasia (AMH) is characterized by a medical history of hypertension, excessive catecholamine excretion, and histomorphometric evidence of increased adrenomedullary tissue relative to the cortex in the absence of multiple endocrine neoplasia. The aim of this study was to perform a retrospective analysis of patients after laparoscopic adrenalectomy for AMH, an early form of sporadic adrenal medulla-related endocrine hypertension, as well as to update our understanding of the clinical features and management of this clinicomorphologic entity. METHODS We performed a retrospective review of the medical records of patients operated on between 2007 and 2011 at Reina Sofia University General Hospital, Murcia, Spain, with a diagnosis of AMH. Patient characteristics, diagnostic studies, surgical procedures, and histologic findings were analyzed. RESULTS Seven hypertensive patients with intermittent adrenergic crises were found to have AMH (3 men and 4 women; mean age, 44 years). Catecholamine levels were increased. Radiologic studies included 1 or more of the following: magnetic resonance imaging, computed tomography, positron emission tomography imaging with fluorodeoxyglucose, dihydroxyphenylalanine-positron emission tomography-computed tomography, Octreoscan (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) and (123)I-metaiodobenzylguanidine scintigraphy. Laparoscopic adrenalectomy was performed in all cases. One patient underwent bilateral adrenalectomy because of persistent symptomatology after unilateral adrenalectomy. Surgery was associated with normalization of catecholamine hypersecretion and complete disappearance of symptoms, as well as the reduction or abstention of antihypertensive therapy. CONCLUSIONS Sporadic AMH is a clinicomorphologic entity that may mimic pheochromocytoma clinically. Recent advances in diagnostic and surgical methods have changed the management and outcome of this unusual disease. Laparoscopic adrenalectomy may be recommended as the gold standard in the treatment of this entity. Definitive diagnosis is provided by histologic study.

Primary mucinous cystadenocarcinoma of the testis: An extremely rare ovarian-type surface epithelial carcinoma.

Primary mucinous epithelial tumors of the testis are extremely rare. Although isolated case reports and small series have been published, these interesting neoplasms are less well-known. We report a case of a primary intratesticular mucinous cystadenoma in an asymptomatic 44-year-old man. Right radical orchiectomy was performed because a malignant testicular tumor was suspected. We discuss the management of this uncommon testicular tumor based on the limited reports.

Hallazgos ecográficos asociados al cáncer de vesícula biliar

OBJECTIVE This article reviews the most relevant ultrasound findings associated with gallbladder cancer. MATERIAL AND METHOD A descriptive and retrospective study was made of clinical features and imaging studies in patients subjected to surgery for gallbladder neoplasm in the Reina Sofía General University Hospital (Murcia) during the time period 2000-2011. RESULTS A total of 15 cases of gallbladder cancer were found during the study period, 9 of whom were women. The mean age was 77 years (range 61-96). Pain was the principal complaint. The patients had cholelithiasis in 13 cases, smoking in 2 cases, and obesity in 3 cases. The ultrasound showed gallbladder wall thickening (>4mm) in 8 cases, intraluminal mass in 4, scleroatrophic gallbladder in 2, and mass replacing the gallbladder in one. Only in 4 cases was the suspicion of gallbladder carcinoma established preoperatively. According to the pTNM staging, 4 patients were carcinoma in situ (Tis), one case T1a, 6 cases T2, 3 cases T3 and one case T4. In 7 cases, the only evidence was the preoperative ultrasound, and in 8 the study was completed with an abdominal CT. CONCLUSION Early diagnosis of gallbladder cancer is rare. The ultrasound diagnostic approach is difficult; only a localized thickening coexisting with gallstones seems to be significant, and requires a biopsy. The image of a mass and a stone occupying the gallbladder is associated with later stages of the disease.OBJECTIVE This article reviews the most relevant ultrasound findings associated with gallbladder cancer. MATERIAL AND METHOD A descriptive and retrospective study was made of clinical features and imaging studies in patients subjected to surgery for gallbladder neoplasm in the Reina Sofía General University Hospital (Murcia) during the time period 2000-2011. RESULTS A total of 15 cases of gallbladder cancer were found during the study period, 9 of whom were women. The mean age was 77 years (range 61-96). Pain was the principal complaint. The patients had cholelithiasis in 13 cases, smoking in 2 cases, and obesity in 3 cases. The ultrasound showed gallbladder wall thickening (>4mm) in 8 cases, intraluminal mass in 4, scleroatrophic gallbladder in 2, and mass replacing the gallbladder in one. Only in 4 cases was the suspicion of gallbladder carcinoma established preoperatively. According to the pTNM staging, 4 patients were carcinoma in situ (Tis), one case T1a, 6 cases T2, 3 cases T3 and one case T4. In 7 cases, the only evidence was the preoperative ultrasound, and in 8 the study was completed with an abdominal CT. CONCLUSION Early diagnosis of gallbladder cancer is rare. The ultrasound diagnostic approach is difficult; only a localized thickening coexisting with gallstones seems to be significant, and requires a biopsy. The image of a mass and a stone occupying the gallbladder is associated with later stages of the disease.

Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. An 83-year-old man who had mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter is presented. The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery.

Intussusception After Bariatric Surgery

A case of bowel intussusception in a 43-year-old woman with a history of Roux-en-Y gastric bypass surgery is presented.A case of bowel intussusception in a 43-year-old woman with a history of Roux-en-Y gastric bypass surgery is presented.

After Cesarean vesicouterine fistula (Youssef Syndrome) with successful conservative management

Vesicouterine fistula without vaginal leakage of urine, cyclic hematuria and amenorrhea is a rare condition, identified as Youssef’s syndrome. The most common cause of this syndrome is trauma during a cesarean section. Different therapeutical approaches that include conservative treatment, fulguration, hormonal therapy and open, laparoscopic or robotic surgeries have been mentioned in the literature. Herein a case in a 37-year-old patient is reported. Conservative treatment with urinary drainage was successful because the fistula was recognized in the immediate postoperative period.

Frequency and causes of conversion from laparoscopic to open Roux-en-Y gastric bypass for morbid obesity: the experience in our service.

Dear Editor Roux-en-Y gastric bypass (RYGBP) is a highly successful approach to morbid obesity. The majority of patients undergoing bypass surgery can expect to lose 60–70 % of excess body weight and maintain that weight loss. Serious complications after this operation are not unusual, however. The laparoscopic approach may decrease the incidence of some complications that are associated with the traditional open approach and may offer benefits, including a reduction in postoperative pain and complications, a shorter hospital stay, and faster recovery, but without decreasing the ultimate weight loss effect of the bypass. Not all patients, however, can have the operation completed totally laparoscopically [1]. Conversion from laparoscopic to open RYGBP is expensive and time-consuming [1] so we analyzed the factors determining this modification in the technique.

Enterolitiasis no obstructiva, presentación de 2 casos

Enterolithiasis, or coprolithiasis, stones formed mainly in the intestine, is uncommon in humans and is generally associated with intestinal stasis. This entity is highly common in some animals, such as horses. Enterolithiasis is usually asymptomatic but may lead to intestinal occlusion and should be considered as a possible cause of this event. We report two cases of enterolithiasis, in which the diagnosis was established by simple abdominal radiography and computed tomography. Although both patients had factors favoring the development of enterolithiasis, a genetic substrate predisposing them to this uncommon clinical entity cannot be excluded.