Artículos (Cirugía)

URI permanente para esta colecciónhttps://hdl.handle.net/11441/11000

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Personalized subperiosteal implant-supported obturator for the rehabilitation of rhino-orbit-cerebral mucormycosis sequela: A case report
(Spandidos publ ltd, 2024) Parras-Hernández, J; Tofé-Povedano, A; Herce-López, J; Matute-García, D; Martínez-Carapeto, E; Cuadrado-Caballero, G; Rollón Mayordomo, Ángel; Universidad de Sevilla. Departamento de Cirugía; Avinent Implant System S.L.U.; Universidad de Sevilla. CTS-410: Epidemiologia del cáncer
Severe atrophy of the maxilla occasionally renders it impossible to place standard endosseous implants to replace absent teeth. For such cases, personalized subperiosteal implants (PSI) are presented as a treatment alternative. Due to novel design and manufacturing technologies, PSIs are fitted closely to the bone structure of the patient, after defining the anchorage areas where the bone is of higher quality and allowing a passive dental prosthesis to be attached to restore function and aesthetics to the patient. The present case report documents a patient with severe bone defects as a sequela of rhino‑orbit‑cerebral mucormycosis. After a failed microvascular fibula flap reconstruction, the patient was treated with a removable implant‑supported prosthesis attached to a PSI, which provided occlusion with the mandible of the patient and closed the oronasal‑antral communication defect. At 18 months after treatment, the patient felt well, with no biological complications and the prosthesis was well adjusted and with good function. Consequently, we consider that in some cases such as this, a customized solution of this type can avoid complex reconstruction treatments.
Study of the impact on zygomatic bone using numerical simulation
(MDPI, 2024-11-14) Ruiz-de-León, Gonzalo; Baus Domínguez, María; González Martín, María Isabel; Gutiérrez Corrales, Aída; Torres-Carranza, Eusebio; Martínez-González, Álvaro-José; Torres-Lagares, Daniel; López Millán, Jose Manuel; Ambrosiani Fernández, Jesús; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Anatomía y Embriología Humana; Universidad de Sevilla. CTS-1050: Cuidados Complejos, Cronicidad y Resultados en Salud; Universidad de Sevilla. CTS-523: Innovación y desarrollo en técnicas y fundamentos de cirugía bucal y craneofacial; Universidad de Sevilla. CTS-1037: Abordaje multidisciplinar de la patología rinosinusal, otológica y de base de cráneo
The zygomatic bone, a fundamental structure in facial anatomy, is exposed to fractures in impact situations, such as traffic accidents or contact sports. The installation of zygomatic implants can also alter the distribution of forces in this region, increasing the risk of fractures. To evaluate this situation, the first step is to develop a complex anatomical model from the stomatognathic point of view so that simulations in this sense can be validated. This study uses numerical simulation using a finite-element method (FEM) to analyze the behavior of the zygomatic bone under impacts of different velocities, offering a more realistic approach than previous studies by including the mandible, cervical spine, and masticatory muscles. Methods: An FEM model was developed based on 3D scans of actual bones, and simulations were performed using Abaqus Explicit 2023 software (Dassault Systemes, Vélizy-Villacoublay, France). The impact was evaluated using a steel cylinder (200 mm length, 40 mm diameter, 2 kg weight) impacted at speeds of 5, 10, 15, and 20 km/h. Zygomatic, maxillary, and mandibular bone properties were based on dynamic stiffness parameters, and bone damage was analyzed using ductile fracture and fracture energy criteria. Results: The results show that at impact velocities of 15 and 20 km/h, the zygomatic bone suffered crush fractures, with impact forces up to 400 kg. At 10 km/h, a combination of crushing and bending was observed, while at 5 km/h, only local damage without complete fracture was detected. The maximum stresses were concentrated at the zygoma–jaw junction, with values above 100 MPa at some critical points. Conclusion: The FEM model developed offers a detailed representation of the mechanical behavior, integrating the main structures of the stomatognathic apparatus of the zygomatic bone under impact, providing valuable information to, for example, advance injury prevention and zygomatic implant design. Higher impact velocities result in severe fractures, underscoring the need for protective measures in clinical and sports settings.
Influence of transperineal ultrasound on the POP-Q system in the surgical indication of symptomatic pelvic organ prolapse
(MDPI, 2024-10-18) García Mejido, José Antonio; Hurtado-Guijosa, Ana; Fernández-Gomez, Alfonso; Fernández-Palacín, Fernando; Lao-Peña, Carolina; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS-971: Sistema Sanitario Público de Andalucía. Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI)
Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our objective is to determine how transperineal ultrasound can influence the surgical indication for symptomatic POP. Methods: This is a prospective observational study conducted over two years including patients who underwent corrective surgery for symptomatic POP. All patients underwent a preoperative examination using the POP-Q system to assess POP. Patients in whom the pelvic floor specialist had diagnostic doubts about the stage of POP underwent an ultrasound examination of the POP. Before the surgical procedure and with the patient anesthetized, a new clinical examination was performed using the POP-Q system and surgical correction of the POP was executed when the patient had a decline to stage II or higher. Cohen’s kappa coefficient of agreement was used to assess the agreement. Results: Of the 180 patients who met the inclusion criteria, 167 were included (99 with preoperative clinical examination and 68 with preoperative clinical examination and ultrasound study). The kappa index for the diagnosis of surgical uterine prolapse of the preoperative clinical examination (moderate correlation) was lower than the ultrasound examination (very good correlation) (0.493 p < 0.001 and 0.924 p < 0.001). The kappa index for the diagnosis of cervical elongation without surgical uterine prolapse also showed differences between the preoperative clinical examination (good correlation) and the ultrasound examination (very good correlation) (0.749 p < 0.001 and 0.853 p < 0.001). Conclusions: Transperineal ultrasound has a higher concordance than presurgical clinical examination, based on the POP-Q system, for detecting POP with central compartment surgical indication.
Intervention strategies to reduce maternal mortality in the context of the sustainable development goals: a scoping review
(MDPI, 2024-10-28) Olea-Ramirez, Lucia Macarena; León Larios, Fátima; Corrales-Gutiérrez, Isabel; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Enfermería; Universidad de Sevilla. HUM-873: Centro de Investigación y Acción Comunitaria de la Universidad de Sevilla; Universidad de Sevilla. CTS-607: Salud reproductiva de la mujer
According to the United Nations Population Fund, approximately every two minutes, a woman dies, totalling approximately 800 deaths per day for reasons related to a maternal causes. Therefore, within the Sustainable Development Goals of the 2030 Agenda, the goal is to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births by 2030. We aim to analyse strategies to reduce maternal mortality in the context of the Sustainable Development Goals, identify barriers that hinder their implementation, and analyse the impact of the COVID-19 pandemic on their achievement. We performed a scoping review of the following databases and distributors of specialised information in the health area: PubMed, Medes, Lilacs, Cuiden, Cinahl, Scopus, SciELO, and websites of the United Nations (UN), United Nations Population Fund (UNFPA), and Cooperanda. A total of 24 articles were reviewed. The results obtainded determined that reviewed studies agree that despite efforts to reduce maternal mortality, significant social and structural barriers still exist in developing countries that slow the implementation of strategies to protect maternal health, especially in the most at-risk populations, and the improvement of the health system. The main strategy consists of increasing the number of deliveries attended by qualified personnel, which is the greatest indicator of progress in reducing maternal mortality. To conclude, Economic, social, and political barriers remain in developing countries in the context of the Sustainable Development Goals. The intervention that has shown the most success is the attendance of deliveries by qualified personnel. It is essential to prioritise maternal care, triangular cooperation, and effective connection between the different Sustainable Development Goals.
Clasificación pronóstica de los tumores malignos de glándula parótida
(Elsevier, 2016-03) Maza Solano, Juan Manuel; Sánchez Gómez, Serafín; Herrero-Salado, Tomás; Benavente Bermudo, Gustavo; Ventura-Díaz, Julio; De Mingo Fernández, Emilio J.; Universidad de Sevilla. Departamento de Cirugía
Objetivo: La clasificación histológica de la Organización Mundial de la Salud (OMS) junto con mejores estudios de imagen aportan información relevante para el manejo de los cánceres de parótida. Sin embargo, su pronóstico depende de otros factores diferentes de la histología y la extensión tumoral. El presente trabajo valora la utilidad de la clasificación pronóstica de Vander Poorten creada en 1999 de los cánceres parotídeos que incluye todos estos factores en los pacientes de nuestro medio. Métodos: Seguimiento de 19 pacientes con carcinomas de parótida distintos de tumores linfoideos o metástasis intraparotídeas entre los años 1998 y 2012. Se obtuvo su índice pronóstico a partir de las fórmulas propuestas por Vander Poorten, que incluyen los factores de edad, tamaño tumoral, afectación ganglionar, invasión cutánea, afectación del nervio facial, crecimiento perineural y márgenes de resección, antes de la cirugía (PS1) y después (PS2). Se relacionó la supervivencia global a los 5 años de cada paciente a partir de su inclusión en alguno de los 4 grupos de riesgo definidos. Resultados: La estratificación de riesgo de Vander Poorten según los resultados PS2 se distribuyó en grupos de riesgo (GR) 1 (3 pacientes, 15,7%), 2 (5 pacientes, 26,3%), 3 (un paciente, 5,8%) y 4 (10 pacientes, 52,2%). Los 6 pacientes que fallecieron durante el seguimiento pertenecían al GR4. De los 4 supervivientes del GR4 solo uno ha superado el seguimiento de 5 años. La comparación de las medias que relacionan las variables de resultado pretratamiento (PS1) y postratamiento (PS2) mostró una mejor supervivencia global en los pacientes con valores de PS1 < 4,5 y PS2 < 4,9, mientras que la mortalidad fue mayor a partir de los índices de PS1 > 6,5 y PS2 > 7,7. Conclusiones: El índice de Vander Poorten es aplicable en áreas hospitalarias con escaso número de carcinomas de parótida. Permite establecer un pronóstico de supervivencia más certero sobre pacientes individuales.
High prevalence of tobacco consumption among pregnant women in a southern European city (Seville): a challenge for the health system
(MDPI, 2024-10-09) Mendoza Berjano, Ramón; León Larios, Fátima; Corrales-Gutiérrez, Isabel; Gomez-Baya, Diego; Medero-Canela, Rocío; Baena-Antequera, Francisca; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Enfermería
The prevalence of prenatal tobacco exposure remains high in many countries, particularly in southern Europe. The aims of this study were to estimate the prevalence of smoking among pregnant women in a southern Spanish city (Seville) and to identify the associated sociodemographic and obstetric characteristics. In a descriptive, cross-sectional study, a random sample of pregnant women who were scheduled to undergo a morphology scan at their public referral hospital in their 20th week of gestation were interviewed in person. At the start of pregnancy, 38.2% of the pregnant women were smokers. In the twentieth week, 19.1% continued to smoke, and the same percentage had quit. The prevalence of smoking in pregnant women was higher among those with a low level of education (60% among pregnant women with no studies and 30.4% in those with primary education) and among those who had had abortions (38.5%). Pregnant smokers with obesity were the least likely to have given up smoking during pregnancy. Women with a lower educational level should be a prime target for cross-sectoral interventions aimed at preventing prenatal tobacco exposure. Implementation of support measures for providing effective clinical advice in preconception and prenatal care regarding healthy lifestyles is particularly needed.
Prevalence of levator hiatal overdistension after vacuum and forceps deliveries
(Wiley, 2020-02-24) Sáinz Bueno, José Antonio; González-Díaz, Enrique; Martínez, Alicia M.; Ortega, Ismael; Fernández-Fernández, Camino; Fernández Palacín, Ana; García Mejido, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Salud Carlos III
Introduction Levator ani avulsion rates after assisted vaginal delivery have been reported in the literature. However, there are no definitive data regarding the association between overdistention and assisted vaginal delivery. Therefore, our aim is to report overdistention rates after assisted vaginal delivery with a postpartum ultrasound examination. Materials and Methods This multicenter study involved a retrospective analysis of data from primiparous women (n = 602) who had previously been recruited at three tertiary hospitals between January 2015 and January 2017. Overdistention was assessed at 6 months postpartum using three-/four-dimensional transperineal ultrasound. Patients with levator ani muscle avulsion were excluded. Overdistention was defined as a levator hiatal area ≥ 25 cm2 on Valsalva. Results Of the 602 primiparous patients, 250 patients who satisfied the inclusion criteria (139 patients who underwent forceps delivery and 111 patients who underwent vacuum delivery) were evaluated. Overdistention occurred in 20% (50 of 250) of these patients. Overdistention was observed for 1% (1/111) of vacuum deliveries and 35.3% (49 of 139) of forceps deliveries. We found an increased risk of overdistention following forceps delivery compared to vacuum delivery, with a crude odds ratio (OR) of 59.9 (95% confidence interval [CI]: 8.1, 442.2) and an adjusted OR (adjusted for maternal age, second-stage duration, and head circumference) of 17.6 (95% CI: 2.3, 136.7). Conclusions Postpartum overdistention occurred for 20% of assisted vaginal deliveries, with an increased risk of overdistention following forceps delivery compared to vacuum delivery.
Long-term outcomes of primary ventral hernia repair associated with rectus diastasis
(Springer, 2024) Sanchez Arteaga, Alejandro; Moreno Suero, Francisco; Feria Madueño, Adrian; Tinoco González, José; Bustos Jimenez, Manuel; Tejero Rosado, Antonio; Padillo Ruiz, Francisco Javier; Tallón Aguilar, Luis; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Educación Física y Deporte; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Primary ventral hernia repair is a common global surgical procedure, entailing economic burdens and recurrence challenges. Rectus diastasis (RD) is considered a risk factor for midline defects, and treatment is symptom-based. When primary ventral hernia and RD coexist, management s*ll remains unclear. This study aims to analyze recurrence rates in pa*ents aEer umbilical/epigastric hernia repair with untreated diastasis. Methods. Observa*onal and retrospec*ve cohort study of 74 pa*ents assessing the recurrence rate of umbilical or epigastric hernias in pa*ents operated with or without RD. Data were obtained from a ter*ary hospital's pa*ents between 2015 and 2017. Medium-term recurrences were analyzed aEer at least 3-year follow up. We compared demographic data, presence of RD (defined as rectus muscles separa*on exceeding 2 cm), type of repair and surgical complica*ons. Results. Data on 74 pa*ents were collected. The mean age was 57.08 years, and the mean BMI was 31.27 Kg/m2. Thirty-one included pa*ents were females (42.9%). RD was documented in 67.1% of the sample. Mean follow-up was 4.23 (+/- 2.53) years. Postopera*ve complica*ons were predominantly grade 1 according to the Clavien-Dindo classifica*on, with a 17.14% surgical site infec*on rate. Female gender (p=0.039), diabetes (0.016), and RD (0.049) showed sta*s*cally significant differences in predic*ng the risk of medium-term recurrence. Conclusion. Pa*ents with untreated RD face a higher risk of medium-term recurrence following primary ventral hernia repair. Addi*onally, female gender and diabetes were found to be independent risk factors. Prospec*ve studies are recommended to further assist surgeons in choosing the op*mal surgical strategy for pa*ents with umbilical hernia and associated RD
A multimodal database for the collection of interdisciplinary audiological research data in Spain
(Asociación Española de Audiología, 2024-09-27) Callejón Leblic, María Amparo; Blanco Trejo, Sergio; Villarreal-Garza, Brenda; Picazo-Reina, Ana María; Tena García, Beatriz; Lara-Delgado, Ana; Lazo-Maestre, Manuel; Sánchez Gómez, Serafín; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Enfermería
Hearing loss constitutes a major disability that hinders communica- tion and quality of life. Recent evidence has uncovered its impact on cognitive decline, thus highlighting its multifactorial dimension and the outstanding need for creating multimodal hearing data- sets that further cover clinical data across different health domains. The aim of this study is to develop a multi-collaborative database to systematically collect and analyze interdisciplinary data for audiological research, including auditory thresholds, speech tests, auditory evoked potentials, cognitive and quality-of-life tests, and medical images, among others. The database has been imple- mented in the Otorhinolaryngology Service of the Virgen Macarena University Hospital in Seville, integrated in the Intranet of the Andalusian Health Service, connected to the electronic patients’ medical records. This database relies on open-source software and complies with national and international guidelines on data protection. A specific registry module has been designed to auto- matically import auditory thresholds and auditory evoked poten- tials from clinical devices into the platform. A mobile app has also been implemented to collect questionnaires from patients remotely. A demo web version of the platform is freely available to the audiology community. The multimodal platform developed paves the way towards a multi-collaborative and unified framework for audiology research in Spain. Nevertheless, support from clini- cians and healthcare stakeholders remains critical to develop more evidence and high-quality multimodal open datasets in hearing research.
Reparación laparoscópica de la hernia inguinal en cirugía mayor ambulatoria: nuestra experiencia inicial
(Arán Ediciones, 2024-09-23) Jurado Jiménez, Rosario María; Briceño Aguero, Victor; Roldán Aviña, Juan Pastor; Berlanga Jiménez, Laura; Pérez de la Fuente, María Jesús; Gómez Bujedo, Lourdes; Parra Membrives, Pablo; Universidad de Sevilla. Departamento de Cirugía
Introducción y objetivo: Presentar nuestra experiencia y resultados en la reparación de la hernia inguinal por vía laparoscópica en régimen de CMA. Métodos: Se realizó un estudio observacional descriptivo retrospectivo de pacientes intervenidos de hernia por laparoscopia en CMA. Se analizaron variables epidemiológicas (edad, sexo, índice de masa corporal [IMC], hipertensión arterial [HTA], diabetes y consumo de tabaco), la comorbilidad acompañante (el riesgo anestésico de la American Society of Anesthesiologists [ASA] y el tipo de hernia) y los datos quirúrgicos (el tiempo y las complicaciones durante la operación y la tasa de conversión a otra técnica) y del seguimiento posoperatorio (ingreso no programado, necesidad de acudir a urgencias, reintervención, complicaciones posoperatorias y recurrencia de hernias). Resultados: Desde enero de 2020 hasta diciembre de 2022 fueron intervenidos 319 pacientes de hernia inguinal laparoscópica, con una edad media de 49.91 años. Hubo 255 hernias unilaterales (79.9 %), 64 bilaterales (20.1 %) y 35 (11 %) recurrentes. La complicación más reiterada durante la operación fue la apertura accidental del peritoneo (45, 14.8 %). 308 pacientes fueron dados de alta en régimen de CMA (96.6 %). Las complicaciones posoperatorias más frecuentes fueron hematoma y seroma (25, 7.8 %) y 15 recurrencias (4.7 %). Conclusiones: El tratamiento laparoscópico de la hernia inguinal es una alternativa eficaz a la cirugía abierta, ya que puede realizarse de forma segura y eficaz, con baja morbilidad posoperatoria y baja tasa de recurrencia, y puede llevarse a cabo en régimen de CMA.
Evaluation of the quality of care of oncologic patients with pain in palliative and pain units based on the achievable benchmarks of care (ABC): project 25Q
(Springer Science and Business Media LLC, 2018-06-14) Villegas-Estévez, Francisco; López-Alarcón, Mª Dolores; Jiménez-López, Antonio Javier; Sanz-Yagüe, Almudena; Soler-López, Begoña; 25Q-Study Group; López Millán, Jose Manuel; Universidad de Sevilla. Departamento de Cirugía
Background: Current guidelines on the management of cancer pain include information referred to integral patient management, in order to get an improvement in their quality of care. The assessment of compliance with the recommendations in daily practice constitutes a necessary feedback mechanism for consolidating theoretical recommendations. The objective of the study was to evaluate the fulfilment of quality of care recommendations for patients with cancer pain in real clinical practice. Methods: A retrospective observational study was designed. A total of 107 centres (81 pain units and 26 palliative care units) collected pooled information on 1605 patients. The study coordinating committee selected 12 structure and 13 process quality indicators based on the recommendations of different clinical practice guidelines. The process indicators were evaluated through the information obtained from 15 consecutively and retrospectively selected case histories. For each indicator, the participating physicians specified compliance or non-compliance, or whether the indicator measurement was not applicable to the reviewed patient. The degree of compliance with the recommendations on the management of patients with cancer pain was evaluated using the Achievable Benchmarks of Care (ABC)© (University of Alabama, Birmingham, AL, USA). Results: Mean compliance with all the indicators was 82.4% (95% CI 70.4–94.4). The ABC of the 13 process indicators selected for the study was 100%. No relevant differences were observed in the degree of compliance with the quality indicators between pain and palliative care units, or between geographical areas. Conclusions: The selected recommendations are applicable to clinical practice and could be used to continuous evaluation of quality of care in patients with cancer. Compliance with the quality indicators in the participating units was very satisfactory.
Evaluation of rectus abdominis muscle strength and width of hernia defect in patients undergoing incisional hernia surgery
(Springer, 2023) Garcia Moriana, A J; Sanchez Arteaga, A; Gil Delgado, J L; Feria Madueño, Adrian; Tallón Aguilar, Luis; Padillo Ruiz, Francisco Javier; Sañudo Corrales, Francisco de Borja; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Educación Física y Deporte; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico; Universidad de Sevilla. CTS664: Cirugia Avanzada y Trasplantes. Terapia Celular y Bioingenieria Aplicada a la Cirugia
Background The aim of this study was to analyze the strength status of the rectus abdominis muscle in patients with incisional hernia and the relationship between the width of the hernia defect and the strength of the rectus abdominis muscle. Methods This is a observational cohort study of patients with medial line incisional hernia (July–October 2022), classified as W2 according to the European Hernia Society (EHS). The data collected were demographic and clinical characteristics related to hernia, and measure of the rectus abdominis muscle strength using an isokinetic dynamometer and a strain gauge. We analyzed the relationship between hernia width and rectus abdominis muscle strength with correlation tests to adjustment by age, sex, BMI, and body composition. Results A total of 40 patients (64% female) with a mean age of 57.62 years (SD 11) were enrolled in the study. The mean BMI was 29.18 (SD 5.06), with a mean percentage of fat mass of 37.8% (SD 8.47) and a mean percentage of muscle mass of 60.33% (SD 6.43). The maximum width of the hernia defect was 6.59 cm (SD 1.54). In the male group, the mean bending force moment (ISOK_PT) was 94.01 Nw m (SD 34.58), bending force moment relative to body weight (ISOK_PT_Weight) was 103.32 Nw m (SD 37.48), and peak force (PK_90) was 184.71 N (SD 47.01). In the female group, these values were 58.11 Nw m (SD 29.41), 66.48 Nw m (SD 32.44), and 152.50 N (SD 48.49), respectively. Statistically significant differences were observed in the relationship between the data obtained with the isokinetic dynamometer and sex (p = 0.002), as well as between the data obtained with the isokinetic dynamometer and age (p = 0.006). Patients in the 90th percentile (P90) of rectus abdominis muscle strength also had smaller hernia defect widths (p = 0.048). Conclusions In this study, age and sex were identified as the most statistically significant predictor variables for rectus abdominis muscle strength. The width of the hernia defect exhibited a trend towards statistical significance
Intrathecal Ziconotide Infusion Therapy for Oncologic Refractory Neuropathic Pain: Case Report With High-Dose Intraventricular Ziconotide After 15 Years of Treatment
(Wiley, 2024) López Millán, Jose Manuel; Coca-Gamito, Carmen; Universidad de Sevilla. Departamento de Cirugía
Uso adecuado de la prótesis invertida de hombro mediante aplicación del método RAND/UCLA
(Elsevier, 2015) Giráldez Sánchez, Miguel Ángel; Molina-Lindeb, J.M.; Baños-Álvarez, E.; Beltrán Calvo, Carmen; Romero Tabares, Antonio; Lacalle Remigio, Juan Ramón
Objetivo: En las series de casos publicadas sobre artropatía del manguito rotador, tratadas con prótesis invertida de hombro, se analizan factores asociados que pueden influir en su evolución como dolor, edad, calidad ósea o limitación articular. En ningún trabajo se plantea una posible actitud de decisión médica partiendo de estas variables. El objetivo del presente estudio fue desarrollar criterios de uso adecuado de la prótesis invertida de hombro en pacientes con artropatía del manguito rotador a través de escenarios creados con dichas variables. Material y método: Se aplicó el método RAND/UCLA para combinar la evidencia científica disponible con el juicio de 12 expertos en la materia. Los expertos expresaron su opinión de forma cuantitativa sobre cada situación clínica. Se calificaron como adecuadas, cuando los beneficios superaban con margen a los riesgos o consecuencias negativas, o inadecuadas, si los riesgos superaban a los beneficios. Resultados: El panel de expertos, tras dos rondas de puntuación, encontró que de 192 situaciones clínicas planteadas, 22 (11,4%) fueron consideradas adecuadas, 47 (24,5%) dudosas y 123 (64,1%) inadecuadas. El grado de desacuerdo bajó respecto al obtenido en la primera ronda, calificando con desacuerdo 5 indicaciones (2,6%), indeterminadas 82 (42,7%) y con acuerdo 105 (54,7%). Conclusiones: Los panelistas consideraron adecuadas aquellas indicaciones definidas por dolor severo y limitación funcional importante, combinada con lesión del manguito rotador no reparable y edad mayor a 65 años. Otras variables como la calidad ósea, la existencia de un defecto glenoideo o la reparabilidad de la lesión del manguito, podrían afectar la decisión.
Myxofibroma of the maxilla. Reconstruction with iliac crest graft and dental implants after tumor resection
(Medicina oral S.L, 2011) Infante Cossío, Pedro Antonio; Martínez de Fuentes, Rafael; García-Perla García, Alberto; Jiménez-Castellanos Ballesteros, Emilio; Gómez-Izquierdo, Lourdes; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Estomatología
Odontogenic fibromyxomas are benign odontogenic tumors of mesenchymal origin of rare presentation in the oral cavity, which exhibit locally aggressive behavior and are prone to local recurrence. The controversy has mainly been on therapeutic management with recommendations varying, depending on the clinical cases, from simple curettage of lesion to segmental bone resection. We present a case report describing the reconstruction of an osseous defect in the maxilila and the restoration with dental implants in a 32 year old female patient after radical surgical excision due to an odontogenic fibromyxoma with locally aggressive behavior. The primary reconstruction of maxillary discontinuity defect was carried out by an immediate non-vascularized cortico-cancellous iliac crest graft. Using a computer-guided system for the implant treatment-planning, three dental implants were secondary placed in the bone graft by means of flapless implant surgery. The patient was subsequently restored with an implant-supported fixed prosthesis that has remained in continuous function for a period of three years. The surgical, reconstructive and restorative treatment sequence and techniques are discussed
Impact of the coronavirus pandemic on maxillofacial trauma: A retrospective study in southern Spain
(Medicina oral S.L, 2022) Infante Cossío, Pedro Antonio; Fernández Mayoralas Gómez, Macarena; González Pérez, Luis Miguel; Martínez de Fuentes, Rafael; Rollón Mayordomo, Ángel; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Estomatología
Background: The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. Material and Methods: Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). Results: During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) com pared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). Conclusions: The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns.
Can we predict levator ani muscle avulsion in instrumental deliveries through intrapartum transperineal ultrasound?
(Taylor and Francis group, 2019) García Mejido, José Antonio; Fuente Vaquero, Paloma de la; Aquise Pino, Adriana; Castro Portillo, Laura; Fernández Palacín, Ana; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Introduction: To determine whether intrapartum translabial ultrasound (ITU) is useful for the prediction of levator ani muscle (LAM) avulsions in instrumental deliveries (vacuum and forceps). Materials and methods: Prospective, observational study, including (1/2016 − 5/2016) 77 nulliparous women, with singleton pregnancies of ≥37 weeks of gestation and with cephalic presentation, who required vacuum or forceps instrumentation to complete the delivery. The ITU parameters evaluated were Angle of Progression (AoP), Progression Distance (PD), Head Direction (HD), and Midline Angle (MLA), both at rest and with maternal push. Evaluation of LAM avulsion was performed at 6 months postpartum with 3–4D transperineal ultrasound. Complete avulsion was defined as an abnormal insertion of LAM in the lower pubic branch identified in all three central slices. Results: Data from 48 nulliparous women were finally included in the study (34 vacuum and 14 forceps). We observed no difference in obstetric parameters between the two study groups (group with avulsion of LAM −14 cases, 29.2% − and group without avulsion of LAM −34 cases, 70.8%). The “LAM avulsion group” had an AoP and a PD of 136.7 ± 22.4 and 43.5 ± 15.6, respectively, versus 141.6 ± 21.3 and 47.2 ± 16.8 recorded in the group without avulsion (NS), respectively. We obtained a ROC curve for AoP and PD with a push of 0.66 (95% CI, 0.28–1.00) and 0.57 (95% CI, 0.39–0.75), respectively. Conclusions: ITU is not a useful technique to predict the occurrence of LAM avulsion in instrumental deliveries with vacuum or forceps.
Validation of the spanish version of the franciscan hospital for children oral health-related quality of Life questionnaire
(Medicina oral S.L, 2018) Rollón Ugalde, Virginia; Coello Suanzes, José Antonio; Castaño Seiquer, Antonio Luis; Lledo Villar, Emilio; Espinoza-Visval, Ivanna; López Jiménez, Ana María; Infante Cossío, Pedro Antonio; Rollón Mayordomo, Ángel; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Psicología Experimental
Background: The Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHC OHRQOL-Q) is an instrument designed specifically for parents and caregivers of patients with special needs that has not yet been applied in Spain. The aim of this study was to adapt it to Spanish and evaluate its reliability and validity in patients with intellectual disability (ID) treated under general anesthesia. Material and Methods: The study was conducted in two different stages: a) cross-cultural adaptation of the origi nal questionnaire, and b) cross-sectional study on 100 parents and caregivers who completed the piloted FHC OHRQOL-Q. The patients were examined according to the WHO methodology. Dental treatments performed were recorded. Statistical tests were used to evaluate reliability (internal consistency) and validity (content, crite rion, construct and discriminant) of the instrument. Results: The mean age was 24 years (range=4-71 years). The most frequent causes of ID were psychomotor re tardation (25%) and cerebral palsy (24%). The items most frequently answered by parents and caregivers were eating and nutrition problems (80%) and bad breath/taste (57%). Reliability (Cronbach’s alpha coefficient) was considered excellent (alpha=0.80-0.95). The analysis of the factorial validity yielded similar results to the original questionnaire. The high response rate of items (>96%) allowed content validity. Criterion validity was confirmed by a significant correlation with questions on oral health and oral well-being. Discriminant validity was dem onstrated by the significant association of ≥21.5 years of age with worse oral symptoms (p=0.034) and parental concerns (p=0.005), DMFT index ≥3 with daily life problems (p=0.02), ≥4 decayed teeth with daily life problems (p=0.001), and >2 dental extractions with oral symptoms (p=0.000), daily life problems (p=0.002) and parent´s perceptions (p=0.043). Conclusions: The FHC-OHRQOL-Q in Spanish is a reliable and valid instrument to apply in clinical practice to eval uate the impact of OHRQOL in mostly adult patients with ID, accessible to Spanish-speaking parents and caregivers.
Resolution of hydrops fetalis caused by atrioventricular block: good postnatal evolution with terbutaline treatment
(IMR Press, 2017-02-10) Sáinz Bueno, José Antonio; García Mejido, José Antonio; Grueso, J.; Santos, J.; Garrido, R.; Universidad de Sevilla. Departamento de Cirugía
Introduction: Complete atrioventricular block (CAVB) is rarely seen, as it occurs in only 1:11 000 to 1:20 000 newborns. There is a serious risk of mortality in CAVB, mainly in those cases associated with hydrops, fetal cardiac frequency ≤ 55 beats/minute, and pre mature delivery. Case Report: Case of complete atrioventricular block with a poor prognosis (hydrops fetalis and foetal cardiac frequency < 5 beats/minute) caused by anti-La and anti-Ro antibodies. Intrauterine symptoms improved after treatment with terbutaline, permit ting foetal viability and successful postnatal treatment with a cardiac pacemaker. Discussion: In case of complete atrioventricular block of cause autoimmune with poor prognosis should be treated with positive inotropic drugs, anticholinergics or b-mimetic in the attempt to maintain adequate ventricular frequency, and thus prevent hydrops fetalis from occurring.
Type of levator ani muscle avulsion as predictor for the disappearance of avulsion
(Wiley, 2020) García Mejido, José Antonio; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía
Objectives The objective of our study was to establish whether the type of levator ani muscle (LAM) avulsion diagnosed 6 months after delivery influences the integrity of the LAM at 1 year after delivery and determine its influence on the levator hiatus area. Study Design This observational prospective cohort study included 192 primiparous women with vaginal delivery. Transperineal ultrasound examinations were performed at 6 months and 1 year postpartum. Levator hiatus measurements (anteroposterior diameter, transverse diameter, and area) were performed in the plane of minimal dimensions. Complete avulsion was defined based on maximum contraction in multislice mode. Type I LAM avulsion was present when most lateral fibers of the pubovisceral muscle were observed at its insertion at the pubic level (the arch of the elevator remained intact). Type II LAM avulsion was defined as a complete detachment of the pubovisceral muscle from its insertion at the pubic level. Results In total, 192 patients were recruited after delivery; 48 patients were diagnosed with complete LAM avulsion, and 13 patients with avulsion did not attend the second ultrasound follow-up at 1 year after delivery. Thirty-five patients with complete LAM avulsion were included in the study. At 6 months after delivery, 51 LAM avulsions were observed in 35 patients (including bilateral LAM avulsion in 16 cases), of which 54.9% were right avulsions and 45.1% left avulsions. Furthermore, 11 (five right and six left) were type I LAM avulsions at the 6-month assessment, and all of these had disappeared 1 year after delivery. However, none of the type II LAM avulsions (23 right and 17 left) observed at 6 months had disappeared at the second ultrasound examination. There were no differences between the LAM areas detected at the first and second ultrasound examinations (10.2 ± 3.3 vs 9.3 ± 1.8; P = .404). Conclusions The type of LAM avulsion observed at 6 months after childbirth predicts LAM persistence at 1 year postpartum.

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