José Gil

Utilidad de la ecografía dinámica tridimensional en el estudio del suelo pélvico

INTRODUCTION Dynamic endoanal ultrasound has emerged in recent years as a test that could replace the now existing tests in the diagnosis of pelvic floor disorders. The aim of this paper is to determine the usefulness of echodefecography in the diagnosis and evaluation of patients with symptoms of anorrectal obstruction, and show the results obtained after its implementation in a pelvic floor unit, as a complementary tool that could replace conventional defecography. METHODS In this retrospective study we analyzed 66 patients with a mean age of 55 years (19-83), 61 women (92%). All dynamic ultrasound was performed in 3 dimensions and was correlated with symptoms and physical findings in the consultation. A descriptive and inferential study was performed to find a kappa correlation between physical examination and echodefecography. RESULTS The reasons for consultation were: Anorrectal obstruction syndrome 36 patients (54.5%), pelvic organ prolapse 27 patients (40.9%), and anorrectal obstruction syndrome along with pelvic organ prolapse 3 patients (4.5%). The correlation of the 2 groups indicated that echodefecography diagnosed more patients with grade III rectocele, enteroceles, and anismus than the combination of scan-ultrasound-manometry-proctoscopy (Kappa 0.26, 0.38 and 0.21, 95% CI: from 0,07 to 1.00, 0.15 to 1.00 and from 0.12 to 1.00, respectively) (P<.001). Conversely, echodefecography diagnosed less perineal descense (Kappa 0.28, 95% CI: 0.12 to 1.00). CONCLUSIONS Dynamic anal ultrasonography may have a role as a complementary test in patients with pelvic floor disorders, achieving diagnoses that would go undetected by inspection, physical examination and manometry.

Qué hacer cuando se descubre un seudomixoma peritoneal durante la reparación de una hernia de pared abdominal

El seudomixoma peritoneal (PMP) es una rara enfermedad que se caracteriza por la producción y acumulación de abundante cantidad de ascitis mucinosa en el abdomen, generalmente originada por una neoplasia apendicular perforada. Esta mucina intraperitoneal puede acumularse a través del canal inguinal u otro orificio herniario, dando lugar a un cuadro indistinguible de una hernia de pared abdominal. Aunque se trate de una situación poco frecuente, es posible el hallazgo de manera incidental de material mucinoso durante la cirugı́a de reparación herniaria. Presentamos el caso de un paciente con el diagnóstico de PMP descubierto en el trascurso de una cirugı́a por hernia umbilical y discutimos el manejo general de este tipo de pacientes.

Hipec in Ovarian Cancer. Why is it Still the Ugly Duckling of Intraperitoneal Therapy

What kind of intraperitoneal therapy would be recommend for our mother, sister, wife or daughter if she was diagnosed with advanced ovarian cancer and if we were in the office of an experienced surgeon able to achieve an optimal resection or, even better, a complete resection of her disease? If one was a surgeon who believed in postoperative systemic chemotherapy, one’s argument would be based on the results of the study GOG 172 (which coincided with a clinical alert from the NCI of the United States in favor of this modality of intraperitoneal treatment after optimal surgery in patients with ovarian cancer)

Reply to: Use of FDG PET/CT for peritoneal carcinomatosis before hyperthermic intraperitoneal chemotherapy: some considerations.

regions of interest from Tc-99m-MAG3 renograms: validation in patients with normal kidneys and in patients with suspected renal obstruction. Nucl Med Commun 2010; 31:366–374. 3 Samal M, Nimmon CC, Svensson L, Bergmann H. Quantitative analysis of dynamic renal studies-steps towards automation. Presented at the EANM Congress 2004 (HERMES Users Meeting), 4.9.2004, Helsinki, Finland (oral communication).