Artículos (Cirugía)
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Artículo Factores determinantes en la indicación de la prótesis invertida de hombro(Editorial Ciencias Médicas, 2017) Giráldez Sánchez, Miguel Ángel; Molina Linde, Juan Máximo; Baños Álvarez, Elena; Beltrán Calvo, Carmen; Romero Tabares, Antonio; Lacalle Remigio, Juan Ramón; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS312: Análisis de la Demanda SanitariaObjetivo: Desarrollar criterios para determinar las indicaciones apropiadas de la prótesis invertida de hombro en artropatías por lesión del manguito rotador y las variables determinantes de este proceso. Método: Se utilizó un panel de expertos mediante metodología RAND/UCLA con 9 expertos en Traumatología, 2 en Rehabilitación y 1 en Reumatología, que evaluaron 192 casos hipotéticos. Cada experto puntuó mediante una escala del 1 (extremadamente inadecuado) al 9 (extremadamente apropiado). Resultados: 22 casos hipotéticos fueron considerados adecuados. El dolor, limitación funcional, necesidad funcional, defecto glenoideo, edad, artrosis y posibilidad de reparación del manguito rotador son variables determinantes para indicar la implantación de una prótesis invertida de hombro. Conclusiones: El método RAND/UCLA es útil para el estudio de las indicaciones de procedimientos como la prótesis invertida de hombro, y proporciona una lista de las indicaciones adecuadas. Las variables requieren ser validadas mediante estudios prospectivos o revisión de historias clínicas.Artículo Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care(Sociedad Española de Medicina Oral, 2017-10) Reyes Gilabert, Eva; Luque Romero, Luis Gabriel; Bejarano Ávila, Gracia; Garcia Palma, Alfonso; Rollón Mayordomo, Ángel; Infante Cossío, Pedro Antonio; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial; Universidad de Sevilla. CTS410: Epidemiología del CáncerBackground To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). Material and Methods Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). Results The majority were female (57.8%) with a mean age of 33.5+9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6+1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). Conclusions AOS in a HPC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC.Artículo Ultrasound Diagnosis of Pelvic Organ Prolapse Using Artificial Intelligence(MDPI, 2025-05-22) García Mejido, José Antonio; Galán Páez, Juan; Solís Martín, David; Fernández Palacín, Fernando; Fernández Palacín, Ana; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Ciencias de la Computación e Inteligencia Artificial; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Fondo Europeo de Desarrollo Regional (FEDER); Universidad de Sevilla. TIC137: Lógica, Computación e Ingeniería del Conocimiento; Universidad de Sevilla. CTS312: Análisis de la Demanda SanitariaBackground/Objectives: The aim of this study was to design a fully automated hybrid AI-based method, combining a convolutional neural network (CNN) and a tree-based model (XGBoost), which was capable of diagnosing different pelvic organ prolapses (POPs) in a dynamic two-dimensional ultrasound study from the midsagittal plane. Methods: This was a prospective observational study with 188 patients (99 with POP and 89 without POP). Transperineal pelvic floor ultrasound videos were performed, and normality or POP was defined. These videos were subsequently labeled, and an algorithm was designed to detect POP based on three phases: 1. Segmentation—a CNN was used to locate and identify the visible pelvic organs in each frame of the ultrasound video. The output had a very high dimensionality. 2. Feature engineering and dataset construction—new features related to the position and shape of the organs detected using the CNN were generated. 3. The POP predictive model—this was created from the dataset generated in the feature engineering phase. To evaluate diagnostic performance, accuracy, precision, recall, and F1-score were considered, along with the degree of agreement with the expert examiner. Results: The best agreements were observed in the diagnosis of cystocele and uterine prolapse (88.1%) and enterocoele (81.4%). The proposed methodology showed an accuracy of 96.43%, an overall accuracy of 98.31%, a recall of 100%, and an F1-score of 98.18% in detecting the presence of POP. However, when differentiating between the various types of POP, we observed that the precision, accuracy, recall, and F1-score were higher when detecting cystocele and uterine prolapse. Conclusions: We have developed the first predictive model capable of diagnosing POP in a dynamic, bi-dimensional ultrasound study from the midsagittal plane using deep learning and machine learning techniques.Artículo Long-Term Mental Health after High-Density Polyethylene-Based Porous Orbital Implant in Enucleated and Eviscerated Patients(Mdpi, 2024-08-27) Garrido Hermosilla, Antonio Manuel; Martínez-Alberquilla, Irene; Díaz-Ruiz, María C; Monge-Carmona, Raquel; Méndez-Muros, Mariola; López Díaz, Álvaro; Sánchez Margalet, Víctor; Gutiérrez Sánchez, Estanislao; Relimpio-López, María Isabel; Rodríguez de la Rúa Franch, Enrique; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Psiquiatría; Universidad de Sevilla. Departamento de Bioquímica Médica y Biología Molecular e Inmunología; Universidad de Sevilla. CTS1086: Psiquiatría Traslacional; Universidad de Sevilla. CTS151: Bioquímica MedicaObjectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients’ self-esteem was already high before implantation and remained stable over the follow-up.Artículo Objective setup description and satisfaction assessment of spinal cord stimulation for treatment of chronic back and leg pain(Med Crave: Step into the world of research, 2025-04-25) Castro Seoane, Fj; Pinta García, JC de la; Du Four, S; Elzinga, L.; López Millán, José Manuel; Smet, I.; Trinidad Martín, JM; Simonelli, C.; Hanbli, H.; Buschman, R.; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS1050: Cuidados Complejos, Cronicidad y Resultados en SaludObjective: The aim of this survey was to collect user (patient and health care professional) satisfaction, therapy outcomes and device settings from patients who utilize a single spinal cord stimulation model for treatment of chronic pain in day-to-day clinical practice. Methods: The design was a clinical survey. The survey population were patients with chronic back and leg pain receiving spinal cord stimulation therapy, and the health care professionals who treat the patients and program the implantable neurostimulator. Patient data were collected once and at a time when spinal cord stimulation provided stable pain relief. Data was presented in aggregate form. Near 50 data-items were captured per patient, including demographics (e.g., age, gender, prior surgeries), technical data (e.g., implant details, stimulation parameters), patient reported outcomes (e.g., pain change, goal achievement, work) and satisfaction and health care professional satisfaction (e.g., satisfaction with neurostimulator size). Descriptive statistics were used to summarize the data. Continuous variables are summarized by computing mean and standard deviation. Results: Clinical staff from nine European sites independently collected data from 124 patients. Patients were on average 54.3 (±11.2) years old and had chronic pain for 9.9 (±6.0) years. The average time since spinal cord stimulation onset was 2.6 years. The indication for spinal cord stimulation was for overall pain (68.5%, 85/124), leg pain (22.6%, 28/124) and back pain (8.9%, 11/124). On average, patients reported an improvement in pain of 70.3% (± 17.1%) and pain medication was reduced for 82.3% (102/124) of patients. Thirtytwo patients (25.8%) returned to work of whom 16 (12.9%) returned to full time work. Functional goals measured on a VAS scale (0-100), were predefined by 110 patients, mostly for pain/medication reduction, improved quality of life, and mobility. On average, there was an improvement in the predefined goal, of 73.3% (±17.0%). Conclusions: The clinical survey provided an overview of the use of spinal cord stimulation for a specific device and indication in a day-to-day clinical setting.Artículo Prevalencia, hábitos de consumo y complicaciones de los suplementos nutricionales proteicos en adolescentes(Elsevier, 2023-09-15) Millán Jiménez, Antonio; Fernández Fontán, Isabel María; Sobrino Toro, Manuel; Fernández Torres, Bartolomé; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; Universidad de Sevilla. Departamento de CirugíaIntroducción: El consumo de suplementos nutricionales y proteicos por adolescentes puede tener importantes repercusiones para su salud. Material y método: Estudio prospectivo observacional, basado en una encuesta, dirigido a los adolescentes de seis colegios, seleccionados aleatoriamente, de la ciudad de Sevilla. Nuestro objetivo principal es conocer el consumo real de suplementos alimentarios entre la población adolescente, cuantificando su contenido proteico. Resultados: Se obtuvieron 263 respuestas válidas, objetivando una prevalencia de consumo de 19,01% para todos los suplementos nutricionales, de ellos 56,0% tomaban suplementos de proteínas (10,64% del total), con una ingesta media de estas últimas de 0,26 ± 0,18 g/kg/día. El perfil del consumidor de cualquier tipo de suplementos se diferencia del de los que no los utilizan en la edad, el uso de medicación habitual y realizar dieta para perder peso o hiperproteica. Al comparar los adolescentes que ingerían productos proteicos con los no proteicos, la única variación significativa estuvo en el control del consumo. Aunque la mayoría no tiene control externo, en 25,92% de los que tomaban proteínas el seguimiento lo hacía un profesional, vs. 7,38% de los que ingerían suplementos no proteicos. De los consumidores de productos proteicos, 85,18% consiguió el objetivo buscado y 18,51% refirió algún efecto negativo. Conclusiones: La prevalencia de consumo de suplementos proteicos entre los adolescentes de nuestro medio es del 10,64%, en cantidades que suponen un 25% de las proteínas que deben ingerir diariamente. El perfil de consumidor de suplementos proteicos es muy similar al de aquel que toma productos no proteicos.Artículo Idiopathic Neck Pain or Neck Pain of Gastric Origin? A Systematic Review of Rat Experimental Studies on Gastric Harm Pathophysiology and Therapy(Wiley, 2025-05-22) Oliva Pascual-Vaca, Ángel; Navarro-Carmona, Ignacio; Oliva Pascual-Vaca, Jesús; Riquelme, Inmaculada; Luque Romero, Luis Gabriel; López Millán, José Manuel; Universidad de Sevilla. Departamento de Fisioterapia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Cirugía; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS1043: Salud, Fisioterapia y Actividad Física; Universidad de Sevilla. CTS1050: Cuidados Complejos, Cronicidad y Resultados en SaludBackground: Most cases of neck pain are classified as nonspecific or idiopathic pain and show characteristics such as sensitization, hyperalgesia, limited range of motion, and muscle spasm. Visceral disorders can trigger all those features, and gastric disorders are related to neck pain. Furthermore, stress and anxiety are frequently somaticized as neck pain. However, its pathophysiological link has never been determined. Objectives: To identify the electromyographic and postural response to experimental gastric insult in rats. Methods: A systematic review was undertaken. Searches were conducted in the PubMed and Web of Science databases. The date of publication was not limited. References from included articles were assessed. The sample, experimental intervention, and the results were retrieved from each study. Results: Sixteen studies were included. Acromiotrapezius muscle showed the highest activity to gastric damage, being up to 8–10 times higher than abdominal muscles contraction. Also, a postural response compatible with neck muscles spasm was observed. The threshold for reaching cervical spasm was lowered by the addition of stress, gastritis, dyspepsia, ulcers, diabetes, or inflammation of the colon. Increased visceromotor response persisted even more than 60 days after gastric insult, despite no obvious injury was already visible in the stomach. Furthermore, prenatal or neonatal gastric injury also produced gastric hypersensitivity and increased trapezius spasm in adult rats. On the contrary, neck spasm was reduced by reversing diabetes or blocking the gastric receptors and its afferent pathways. Conclusions: Gastric harm triggers neck muscles spasm. Since many gastric conditions and hypersensitivity are common and tend to be chronic, this may contribute to explain the persistence of neck pain and sensitization in many patients. Prenatal and neonatal gastrointestinal suffering increases trapezius visceromotor response in adults. Furthermore, our findings might contribute to explain why stress is frequently somaticized as neck pain.Artículo Usefulness of sonication in the microbiological diagnosis of cardiovascular implantable electronic device infections: systematic review, meta-analysis and meta-regression(Biomed Central (BMC), 2024-11-05) Martín-Gutiérrez, Guillermo; Martín Pérez, Carlos; Ortiz de la Rosa, José Manuel; Gutiérrez Carretero, Encarnación; Alarcón, Arístides de; Lepe Jiménez, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Microbiología; Instituto de Salud Carlos III; Gobierno de España; Universidad de Sevilla. CTS1134: Investigación Traslacional en la Fisiopatología Cardiovascular; Universidad de Sevilla. CTS204: Biotecnología Aplicada al Estudio de Enfermedades InfecciosasBackground Multiple studies have demonstrated the utility of sonication to improve culture yield in patients with cardiovascular implantable electronic device (CIED) infections. Objective To analyze the usefulness of sonication in the microbiological diagnosis of CIED infections in comparison with traditional cultures. Methods Systematic database searches were performed to identify studies that provided enough data concerning both sensitivity and specificity of traditional (non-sonicated) and sonicated cultures from CIED samples. The diagnostic accuracy measures were obtained by three different statistical approaches: (i) The univariate model; (ii) The bivariate random; and (iii) The Bayesian bivariate hierarchical model. Heterogeneity was assessed using meta-regression. Findings Nine studies met the criteria for inclusion in the meta-analysis (1684 cultures). The summary estimates of sensitivity were higher for sonicated cultures (0.756) in comparison with non-sonicated cultures (0.446). On meta-regression, sonication of CIEDs significantly increased the sensitivity (p = 0.001) as well as the rates of false positive results (p = 0.003). The final model also showed that the studies that used a threshold for positivity were associated with lower rates of false positive results (p < 0.001).Artículo Ultrasound, echocardiography, mri, and genetic analysis of a fetus with congenital diaphragmatic hernia and partial 11q trisomy(Hindawi, 2017-03-02) Fernández-Perea, Yolanda; García Díaz, Lutgardo; Sánchez, Javier; Antiñolo Gil, Guillermo; Borrego, Salud; Universidad de Sevilla. Departamento de CirugíaCongenital diaphragmatic hernia (CDH) is a serious birth defect with a significant mortality and morbidity. The current and constant progress in ultrasound techniques has led to the improvement of the prenatal diagnosis of this malformation. CDH is a developmental defect whose etiology is heterogeneous and takes place when the pleuroperitoneal folds and septum transversum fail to converge and fuse. Survival depends on the extent of pulmonary hypoplasia and the disease may be potentially worsened by the presence of added congenital defects. 40% of CDH cases are associated with at least one additional anomaly. The ultrasound diagnosis is established with essential signs: loss of uniform echogenicity of lungs and marked mediastinal shift. We report the case of a fetus with isolated CDH diagnosed at 21 weeks of gestation by ultrasound and confirmed by RMI, whose genetic analysis of amniotic fluid cells identified a de novo partial trisomy of the long arm of chromosome 11. Different genetic causes have been associated with CDH. Moreover, it is expectable that the use of new techniques for prenatal diagnosis will reveal novel CNVs associated with CDH and will help us to estimate the recurrence risk for this defect as well as for other associated anomalies.Artículo Two year neurodevelopmental outcome after fetoscopic laser therapy for twin-twin transfusion syndrome: comparison with uncomplicated monochorionic diamniotic twins(Mdpi Ag, 2023-07-20) Chimenea, Angel; García Díaz, Lutgardo; Antiñolo Gil, Guillermo; Universidad de Sevilla. Departamento de CirugíaBackground: Twin–twin Transfusion Syndrome (TTTS) represents a significant compli cation in monochorionic twin pregnancies, caused by an unbalanced shunting of blood through intertwin placental vascular anastomoses. Despite advances in fetoscopic laser surgery, TTTS is still associated with a high rate of cerebral injury. However, there are no studies comparing these pregnancies with uncomplicated monochorionic diamniotic (MCDA) twin pregnancies, establishing the baseline risk of neurodevelopmental impairment. The aim of this study is to evaluate the odds of neurodevelopmental impairment in MCDA twins who undergo fetoscopic laser surgery for twin twin transfusion syndrome, in comparison to a cohort of uncomplicated MCDA twin pregnancies. Study design: This is a retrospective cohort study of children born from MCDA twin pregnancies at a single center between 2008 and 2019. A routine, standardized follow-up assessment was conducted at a minimumof2years after delivery. The primary outcome of this was a 2 year neurodevelopmental impairment. Neurological, motor, and cognitive development was assessed by using the revised Brunet–Lézine scale. Results: 176 children met the enrolment criteria. Of these, 42 (24%; TTTS group) underwent fetoscopic laser surgery for TTTS during pregnancy, and 134 (76%; uncomplicated MCDA group) were uncomplicated MCDA pregnancies. The primary outcome was found in four children (9.52%) in the TTTS group and ten children (7.46%) in the uncomplicated MCDA group (p = 0.67, aOR2.82, 95% CI 0.49–16.23). Major neurologic impairment was found in 2.38% after fetoscopic laser surgery and 1.49% in uncomplicated MCDA twins (p = 0.70, aOR 0.97, 95% CI 0.22–4.24). The data were adjusted by birth order, birth weight, and gestational age at birth. Conclusions: The outcome in MCDAtwinswhounderwentfetoscopic laser surgery for TTTS is comparable to the outcome in uncomplicated MCDA twins. Our findings emphasize the need for long-term neurodevelopmental follow-ups in all children from monochorionic twin gestations.Artículo Prenatal ultrasound, magnetic resonance imaging and therapeutic options for fetal thoracic anomalies: a pictorial essay(Springer, 2023-05-11) Caro-Domínguez, Pablo; Victoria, Teresa; Ciet, Pierluigi; Torre, Estrella de la; Sáinz Bueno, José Antonio; Chimenea Toscano, Ángel; García Díaz, Lutgardo; Universidad de Sevilla. Departamento de CirugíaCongenital thoracic anomalies are uncommon malformations that require a precise diagnosis to guide parental counseling and possible prenatal treatment. Prenatal ultrasound (US) is the gold standard imaging modality to first detect and characterize these abnormalities and the best modality for follow-up. Fetal magnetic resonance imaging (MRI) is a complementary tool that provides multiplanar assessment and tissue characterization and can help estimate prognosis. Prenatal treatment is increasingly being used in fetuses with signs of distress and to potentially decrease morbidity and mortality. In this essay, the authors illustrate side-by-side US, MRI and therapeutic options for congenital thoracic anomalies in cases that presented to a tertiary pediatric hospital during the 7-year period 2014–2021. Entities included are congenital diaphragmatic hernia, congenital pulmonary airway malformation, bronchopulmonary sequestration, hybrid lesions, foregut duplications cysts and congenital lobar overinflation. Treatment options include maternal steroids, thoraco-amniotic shunt and fetal endotracheal occlusion. Recognition of typical findings in congenital thoracic anomalies is helpful to establish diagnosis, predict prognosis and plan perinatal treatment.Artículo Spanish consensus on managing pregnancy in women with Gaucher disease(Biomed Central Ltd; Bmc (Biomed Central); Bmc, 2025-03-28) Calderón Sandubete, Enrique José; Rodríguez-Fernández, Alicia; Calderón-Baturone, Irene; Aporta-Rodríguez, Rafael; Castillo, Francisco J. del; García Díaz, Lutgardo; González-Meneses, Antonio; Hermosín-Ramos, María Lourdes; Yahyaoui, Raquel; Marín-León, Ignacio; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de CirugíaGaucher disease can have effects on the development of pregnancy, childbirth, and lactation, with impact on health of both the mother and the newborn. Management of pregnancies in Gaucher patients is further complicated by using of enzyme replacement therapy. Unfortunately, the available scientific evidence is not conclusive because there are not proper clinical trials on this issue. The aim of this work was to establish a management guide to address the main clinical problems before, during and after pregnancy and to provide key information to healthcare professionals, patients, and families. GRADE methodology to evaluate the quality of scientific evidence and develop recommendations was incorporated to elaborate this guide. For final recommendations, a structured consensus 2-round process was carried out using the Delphi method with a Gaucher expert panel. After this process, nine recommendations were elaborated related to pre-pregnant status and genetic counseling and for management during pregnancy, seven related to childbirth, and eight focused on management after delivery and breastfeeding. Regarding the quality of the evidence, values and preferences of patients were also considered. A consensus guide to define and standardize pregnancy management in Gaucher disease considering the best available evidence, complemented by experts’ opinions, could be a relevant tool to help patients, nurses, midwives and physicians with little experience in Gaucher disease who do not have access to guidance from Gaucher disease treatment centers of excellence.Artículo Long-term neurodevelopmental outcome after selective fetoscopic laser lherapy for stage I twin-twin transfusion syndrome(Sage Publications Inc, 2024-01-25) Chimenea, Angel; García Díaz, Lutgardo; Antiñolo Gil, Guillermo; Universidad de Sevilla. Departamento de CirugíaTwin-twin transfusion syndrome (TTTS) is a serious complication in monochorionic (MC) pregnancies. Fetoscopic laser surgery (FLS) is the primary treatment for advanced TTTS, but managing Quintero stage I TTTS is still controversial. We conducted an observational study evaluating the 2-year neurodevelopment of fetuses, which underwent FLS for stage I TTTS, compared with advanced TTTS and uncomplicated monochorionic diamniotic twins (MCDTs). The study included 156 children: 14 in stage I TTTS group, 28 in advanced TTTS group, and 114 in uncomplicated twin group. In stage I TTTS, 92.9% showed normal neurodevelopment, with no severe neurological impairments observed. These results were comparable with uncomplicated twins (92.1% normal neurodevelopment, P = .921, adjusted odds ratio [aOR] = 1.56, 95% confidence interval [CI] = 0.42-5.79; 1.8% severe impairment, P = .617). Advanced TTTS had a non-significant lower rate of normal neurodevelopment (89.3%, P = .710, aOR = 1.31, 95% CI = 0.12-14.87). In conclusion, FLS for stage I TTTS shows favorable long-term neurodevelopmental outcomes, similar to uncomplicated MC pregnancies.Artículo Assessing the impact of pregnancy planning on obstetric and perinatal outcomes in women with pregestational diabetes mellitus(Elsevier Ireland Ltd, 2024-03) Chimenea, Ángel; Calderón, Ana María; Antiñolo Gil, Guillermo; Moreno-Reina, Eduardo; García Díaz, Lutgardo; Universidad de Sevilla. Departamento de CirugíaAims We investigated the role of pregnancy planning in improving glycemic control and its potential impact on the overall pregnancy outcomes, obstetric outcomes, and perinatal well-being in women with pregestational diabetes mellitus (PGDM). Methods A retrospective observational cohort study was conducted, including all pregnant women with PGDM treated in our center 2012 and 2018. Results Among 425 participants, 26.6 % had planned pregnancies. The lowest rate of pregnancy planning was observed in women with type 2 diabetes mellitus (6.5 %). Women with planned pregnancies had lower BMI. Both pregestational HbA1c levels (6.66 % vs. 7.61 %, p < 0.001) and HbA1c levels at the first prenatal visit (6.39 % vs. 7.24 %, p < 0.001) were significantly lower in the planned pregnancy group. These differences persisted until the end of pregnancy (6.09 % vs. 6.47 %, p = 0.006). Although better glycemic control was associated with a non-significant decrease in fetuses with birth weight over 4000 g (18.1 % vs. 22.1 %) and 4500 g (3.0 % vs. 4.2 %), we did not find significant effects on other morbidity events, maternal outcomes, or the cesarean section rate. Conclusions Pregnancy planning in PGDM women improved glycemic control and HbA1c levels. Limited impact on obstetric and perinatal outcomes suggests scope for other focused interventions to optimize maternal and fetal health.
Artículo Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series(2024-08) Chimenea, Ángel; Dominguez-Moreno, Marta; Barrera-Talavera, María; García Díaz, Lutgardo; Antiñolo Gil, Guillermo; Universidad de Sevilla. Departamento de CirugíaIntroduction: Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O/E LHR] 26-45%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition. Material and methods: We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery. Results: A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9 mg/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful. Conclusions: In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.Artículo Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series(Biomed Central Ltd; Bmc (Biomed Central); Bmc, 2018-04-06) Chimenea, Ángel; García Díaz, Lutgardo; Calderón, Ana María; Moreno de las Heras, María; Antiñolo Gil, Guillermo; Universidad de Sevilla. Departamento de CirugíaBackground: Mirror syndrome (MS) is a rare obstetric condition usually defined as the development of maternal edema in association with fetal hydrops. The pathogenesis of MS remains unclear and may be misdiagnosed as pre-eclampsia. Case presentation: We report a case series of MS in which fetal therapy (intrauterine blood transfusion and pleuroamniotic shunt) resulted in fetal as well as maternal favourable course with complete resolution of the condition in both mother and fetus. Conclusions: Our case series add new evidence to support that early diagnosis of MS followed by fetal therapy and clinical maternal support are critical for a good outcome.Artículo Maternal and obstetric outcomes after Ex-Utero Intrapartum Treatment (EXIT): a single center experience(Biomed Central Ltd; Bmc (Biomed Central); Bmc, 2023-12-02) Domínguez Moreno, Marta; Chimenea, Ángel; García Díaz, Lutgardo; Antiñolo Gil, GuillermoAbstract and Background The Ex‑utero Intrapartum Treatment (EXIT) is a procedure developed to manage a range of fetal conditions, aiming to ensure the maintenance of neonatal airway and preserving the feto‑placental circulation. Its goal is to enhance the neonatal ability to successfully transition and adapt to postnatal life, thereby reducing perinatal morbidity and mortality. However, EXIT has been associated with a high risk of maternal complications. This paper provides an overview of the indications and characteristics of the EXIT procedure, as well as the obstetric outcomes and maternal complications. Methods A retrospective analysis was conducted on a cohort of patients undergoing EXIT at our center between January 2007 and December 2022. Maternal outcomes, including demographic information, data related to the surgical procedure, surgical complications, and postoperative complications were analyzed. To assess the severity of the surgical complications, a modified Clavien‑Dindo classification was used. Comparative analysis was performed by randomly selecting a sample from elective cesarean deliveries performed at our center. Results A total of 34 EXIT procedures were performed. According to the modified Clavien‑Dindo classification, we observed no major complications, while minor maternal complications were present in 2.94% of cases. Compared to elective cesarean deliveries (n = 350), there were no significant differences in terms of maternal complications, highlighting the similarity observed in the mean decrease in postoperative hemoglobin (1.15 g/dL in EXIT vs. 1.2 g/ dL in elective cesarean deliveries, p = 0.94). In EXIT group, there was a higher rate of polyhydramnios (26.47% vs 6.59%, p < 0.001), as well as the need for amnioreduction (14.71% vs 0%, p = 0.001) and preterm delivery (32.35% vs 6.02%, p = 0.001). There were no cases of endometritis, post‑procedural fever, or abruptio placentae following EXIT. Conclusions EXIT can be considered a safe procedure when performed under adequate conditions, including appropriate uterine access and proper anesthetic management. In our series, EXIT procedure was not associated with a higher incidence of maternal complications when compared to elective cesarean delivery. Trial registration Retrospectively registered.Artículo The fetal growth restriction at term managed by angiogenic factors versus feto-maternal doppler (GRAFD) trial to avoid adverse perinatal outcomes: protocol for a multicenter, open-label, randomized controlled trial(Jmir publications, INC, 2022) García-Manau, Pablo; Mendoza, Manel; Bonacina, Erika; Martín-Alonso, Raquel; Martín, Lourdes; Palacios, Ana; Sánchez, María Luisa; Borrero González, Carlota; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de CirugíaBackground: Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective: The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods: This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results: Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions: The angiogenic factor-based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities.Artículo Foot pressure in patients with chronic lumbar radicular pain (sciatica) caused by lumbar disc herniation: a case-control observational study(Springer, 2025-04-24) Munuera Martínez, Pedro Vicente; Reina Bueno, María; Vázquez-Bautista, Carmen; Domínguez-Maldonado, Gabriel; Martínez Navas, Ángel María; García Rodríguez, María José; Palomo Toucedo, Inmaculada Concepción; Universidad de Sevilla. Departamento de Podología; Universidad de Sevilla. Departamento de Cirugía; Universidad de SevillaObjective This study aimed to determine whether there are differences in plantar pressures during gait between patients with lumbar disc herniation -induced sciatica and healthy individuals. Methods This observational case–control study included 41 patients with sciatica due to lumbar disc herniation and 30 healthy controls. Plantar pressures were evaluated using the FootScan® platform in 10-foot zones during 3 gait phases, defined as rockers. After walking, body advancement with the supporting foot depends on stance–limb mobility, with the supporting foot acting as a pivot system. In a serial fashion, the heel, ankle, and forefoot serve as rockers that allow the body to advance smoothly. Data were also collected on quality of life, low back pain, lower limb pain, foot pain, foot pain-related disability, foot joint range of motion, and foot posture index. All variables were compared between the two groups. Results Patients with sciatica had a longer contact time and higher mean and peak pressures in all foot zones, except for the first metatarsal and toes. Pressures were higher in the third to fifth metatarsals, especially during push-off. Patients with sciatic arthritis experience not only low back pain, but also lower limb and foot pain, as well as higher foot pain-related disability. There were no significant differences in foot posture or joint ranges, except for decreased subtalar pronation in patients with sciatica. Conclusion Altered plantar pressure distribution in patients with sciatica may be associated with neuromuscular compensation mechanisms.Artículo Virtual 3D models, augmented reality systems and virtual laparoscopic simulations in complicated pancreatic surgeries: state of art, future perspectives, and challenges(Ovid Technologies, 2025-01-24) Laga Boul-Atarass, Imán; Cepeda Franco, Carmen; Sanmartín Sierra, José Domingo; Castell Monsalve, Javier; Padillo Ruiz, Francisco Javier; Universidad de Sevilla. Departamento de CirugíaPancreatic surgery is considered one of the most challenging interventions by many surgeons, mainly due to retroperitoneal location and proximity to key and delicate vascular structures. These factors make pancreatic resection a demanding procedure, with successful rates far from optimal and frequent postoperative complications. Surgical planning is essential to improve patient outcomes, and in this regard, many technological advances made in the last few years have proven to be extremely useful in medical fields. This review aims to outline the potential and limitations of 3D digital and 3D printed models in pancreatic surgical planning, as well as the impact and challenges of novel technologies such as augmented/virtual reality systems or artificial intelligence to improve medical training and surgical outcomes.