Artículos (Instituto de Biomedicina de Sevilla (IBIS))

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Impact of SNR, peripheral auditory sensitivity, and central cognitive profile on the psychometric relation between pupillary response and speech performance in CI users
(Frontiers Media, 2023-12-21) Zhang, Yue; Callejón Leblic, María Amparo; Picazo Reina, Ana María; Blanco Trejo, Sergio; Patou, François; Sánchez Gómez, Serafín; Cirugía; Gobierno de España
Despite substantial technical advances and wider clinical use, cochlear implant (CI) users continue to report high and elevated listening effort especially under challenging noisy conditions. Among all the objective measures to quantify listening effort, pupillometry is one of the most widely used and robust physiological measures. Previous studies with normally hearing (NH) and hearing-impaired (HI) listeners have shown that the relation between speech performance in noise and listening effort (as measured by peak pupil dilation) is not linear and exhibits an inverted-U shape. However, it is unclear whether the same psychometric relation exists in CI users, and whether individual differences in auditory sensitivity and central cognitive capacity affect this relation. Therefore, we recruited 17 post-lingually deaf CI adults to perform speech-in-noise tasks from 0 to 20 dB SNR with a 4 dB step size. Simultaneously, their pupillary responses and self-reported subjective effort were recorded. To characterize top-down and bottom-up individual variabilities, a spectro-temporal modulation task and a set of cognitive abilities were measured. Clinical word recognition in quiet and Quality of Life (QoL) were also collected. Results showed that at a group level, an inverted-U shape psychometric curve between task difficulty (SNR) and peak pupil dilation (PPD) was not observed. Individual shape of the psychometric curve was significantly associated with some individual factors: CI users with higher clinical word and speech-in-noise recognition showed a quadratic decrease of PPD over increasing SNRs; CI users with better non-verbal intelligence and lower QoL showed smaller average PPD. To summarize, individual differences in CI users had a significant impact on the psychometric relation between pupillary response and task difficulty, hence affecting the interpretation of pupillary response as listening effort (or engagement) at different task difficulty levels. Future research and clinical applications should further characterize the possible effects of individual factors (such as motivation or engagement) in modulating CI users’ occurrence of ‘tipping point’ on their psychometric functions, and develop an individualized method for reliably quantifying listening effort using pupillometry. (excerpt)
Laparoscopic vs. Open Approach in Emergent Inguinal Hernia: Our Experience and Review of Literature
(Frontiers Media, 2023-06-16) Moreno Suero, Francisco; Tallón Aguilar, Luis; Tinoco González, José; Sánchez Arteaga, Alejandro; Suárez Grau, Juan Manuel; Álvarez Aguilera, Miriam; Morales Conde, Salvador; Padillo Ruiz, Francisco Javier; Cirugía; CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
There is currently no consensus or homogeneous recommendation about the role of the laparoscopic approach in emergent inguinal hernia surgery. The aim of this manuscript is showing our experience and results of laparoscopic approach for emergent groin hernia repair comparing with open approach. A retrospective review of a prospectively maintained database between January 2011 and December 2021 of acute incarcerated groin hernia that were operated at Virgen del Rocio University Hospital. In this period, they were identified 463 patients with groin hernia that required an emergency repair. 454 patients underwent open surgery (group 1) and 36 patients underwent laparoscopic approach (TAPP procedure) (group 2). Median length stay was 1 day in lap group and 2 days in open approach. Reintervention was necessary in 20 cases (4.40%) from group 1 and one (2.27%) from group 2. In laparoscopic approach, no mortality was described but in open approach, 10 patients (2.20%) died. Globally, 58 cases (12.77%) from group 1 and six patients (16.66%) from group 2 presented any complication. Wound infection was higher in group of open repairs (5.94% vs. 2.77%). Non-surgical complications were higher in open approach (19 vs. 0). There is no statistical significance in any of these items. Laparoscopic approach is a safe, feasible and effective therapeutic option for the treatment of incarcerated groin hernia that require emergency surgery, but prospective and randomized comparative studies are needed to establish the best approach.
Multi-Session whole body vibration program on parkinson’s disease symptoms: systematic review and meta-analysis
(Elsevier, 2025-10-17) González García, Paula; Heredia Rizo, Alberto Marcos; Garrido-Bueno, Alfonso; Casuso-Holgado, María Jesús; García-Bernal, María-Isabel; Fisioterapia; Instituto de Biomedicina de Sevilla (IBIS); CTS1043: Salud, Fisioterapia y Actividad Física; CTS1110: Understanding Movement & Self in Health from Science
Background: Parkinson’s disease is a disorder with a growing prevalence that significantly reduces the quality of life of those affected. Purpose: This review aims to analyze the effects of whole-body vibration on Parkinson’s disease symptoms. Methods: A systematic search was carried out in PubMed, CINHAL, EMBASE, and the Cochrane Library for randomized clinical trials studying the use of whole-body vibration interventions involving more than one session on Parkinson’s Disease related symptoms. The Cochrane Risk of Bias Assessment Tool-2 was used to assess the methodological quality and the GRADE and TIDierR evaluated the certainty of the evidence and replicability of studies. Extracted data was pooled in meta-analysis. Results: Six studies met the selection criteria. The TIDieR scores indicated high replicability. Whole-body vibration interventions improved static balance compared to active controls. No differences were found for gait speed, functional mobility, or motor symptoms. There were high concerns about the risk of bias and the certainty of the evidence. Conclusions: Whole-body vibration showed no better effect than controls to improve Parkinson’s disease symptoms, except for static balance. No clinical recommendations can be made due to the low number of studies and serious methodological issues.
Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008–2021)
(Oxford University Press, 2023-08-09) Alonso Menchén, David; Bouza, Emilio; Valerio, Maricela; Alarcón, Arístides de; Gutiérrez Carretero, Encarnación; Miró, José M.; López-Cortés, Luis E.; Muñoz, Patricia; Cirugía; Instituto de Salud Carlos III; European Union (UE); CTS1134: Investigación Traslacional en la Fisiopatología Cardiovascular
Background: Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity. Methods: This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data. Results: IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40). Conclusions: Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
(Wolters Kluwer Health, 2023-10-04) The LiverGroup.org Collaborative; Padillo Ruiz, Francisco Javier; Gómez Bravo, Miguel Ángel; Cirugía; CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.
Parp Inhibitors and Radiotherapy: A New Combination for Prostate Cancer (Systematic Review)
(MDPI, 2023-08-19) Rivero Belenchón, Inés; Congregado Ruiz, Carmen Belén; Saez, Carmen; Osmán García, Ignacio; Medina López, Rafael; Cirugía
PARPi, in combination with ionizing radiation, has demonstrated the ability to enhance cellular radiosensitivity in different tumors. The rationale is that the exposure to radiation leads to both physical and biochemical damage to DNA, prompting cells to initiate three primary mechanisms for DNA repair. Two double-stranded DNA breaks (DSB) repair pathways: (1) non-homologous end-joining (NHEJ) and (2) homologous recombination (HR); and (3) a single-stranded DNA break (SSB) repair pathway (base excision repair, BER). In this scenario, PARPi can serve as radiosensitizers by leveraging the BER pathway. This mechanism heightens the likelihood of replication forks collapsing, consequently leading to the formation of persistent DSBs. Together, the combination of PARPi and radiotherapy is a potent oncological strategy. This combination has proven its efficacy in different tumors. However, in prostate cancer, there are only preclinical studies to support it and, recently, an ongoing clinical trial. The objective of this paper is to perform a review of the current evidence regarding the use of PARPi and radiotherapy (RT) in PCa and to give future insight on this topic.
Evaluation of alpha1 antitrypsin deficiency-associated mutations in people with cystic fibrosis
(MDPI, 2025-09-25) López-Campos Bodineau, José Luis; García Tamayo, Pedro; Girón, Maria Victoria; Delgado Pecellín, Isabel; Olveira, Gabriel; Carrasco, Laura; Quintana-Gallego, Esther; Medicina; Farmacología, Pediatría y Radiología
Background: Recent hypotheses suggest that mutations associated with alpha1 antitrypsin (AAT) deficiency (AATD) may influence the clinical presentation and progression of cystic fibrosis (CF). This study employs a longitudinal design to determine the prevalence of AATD mutations and assess their impact on CF. Methods: The study Finding AAT Deficiency in Obstructive Lung Diseases: Cystic Fibrosis (FADO-CF) is a retrospective cohort study evaluating people with CF from November 2020 to February 2024. On the date of inclusion, serum levels of AAT were measured and a genotyping of 14 mutations associated with AATD was performed. Historical information, including data on exacerbations, microbiological sputum isolations, and lung function, was obtained from the medical records, aiming at a temporal lag of 10 years. Results: The sample consisted of 369 people with CF (40.9% pediatrics). Of these, 58 (15.7%) cases presented at least one AATD mutation. The AATD allelic combinations identified were PI*MS in 47 (12.7%) cases, PI*MZ in 5 (1.4%) cases, PI*SS in 3 (0.8%) cases, PI*SZ in 2 (0.5%) cases, and PI*M/Plowell in 1 (0.3%) case. The optimal cutoff value for AAT levels to detect AATD-associated mutation carriers was 129 mg/dL in the overall cohort (sensitivity of 73.0%; specificity 69.2%) and 99.5 mg/dL when excluding PI*MS cases (sensitivity 98.0%; specificity 90.9%), highlighting the need for lower thresholds in clinically severe genotypes to improve case detection. The number of mild exacerbations during the follow-up appeared to be associated with AATD mutations. Conclusions: AATD mutations are prevalent in CF and may impact certain clinical outcomes. If systematic screening was to be planned, we recommend considering the proposed cut-off points to select the population for genetic studies.
Quantification and Characterization of CTCs and Clusters in Pancreatic Cancer by Means of the Hough Transform Algorithm
(MDPI, 2023-01-21) Calero Castro, Francisco José; Pereira, Sheila; Laga, Imán; Villanueva, Paula; Suárez Artacho, Gonzalo; Cepeda Franco, Carmen; Cruz Ojeda, Patricia de la; Navarro Villarán, Elena; Dios Barbeito, Sandra; Serrano, María José; Fresno, Cristóbal; Padillo Ruiz, Francisco Javier; Cirugía; Instituto de Salud Carlos III; European Union (UE); CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
Circulating Tumor Cells (CTCs) are considered a prognostic marker in pancreatic cancer. In this study we present a new approach for counting CTCs and CTC clusters in patients with pancreatic cancer using the IsofluxTM System with the Hough transform algorithm (Hough-IsofluxTM). The Hough-IsofluxTM approach is based on the counting of an array of pixels with a nucleus and cytokeratin expression excluding the CD45 signal. Total CTCs including free and CTC clusters were evaluated in healthy donor samples mixed with pancreatic cancer cells (PCCs) and in samples from patients with pancreatic ductal adenocarcinoma (PDAC). The IsofluxTM System with manual counting was used in a blinded manner by three technicians who used Manual-IsofluxTM as a reference. The accuracy of the Hough-IsofluxTM approach for detecting PCC based on counted events was 91.00% [84.50, 93.50] with a PCC recovery rate of 80.75 ± 16.41%. A high correlation between the Hough-IsofluxTM and Manual-IsofluxTM was observed for both free CTCs and for clusters in experimental PCC (R2 = 0.993 and R2 = 0.902 respectively). However, the correlation rate was better for free CTCs than for clusters in PDAC patient samples (R2 = 0.974 and R2 = 0.790 respectively). In conclusion, the Hough-IsofluxTM approach showed high accuracy for the detection of circulating pancreatic cancer cells. A better correlation rate was observed between Hough-IsofluxTM approach and with the Manual-IsofluxTM for isolated CTCs than for clusters in PDAC patient samples.
Substance P and Neurokinin-1 Receptor System in Thyroid Cancer: Potential Targets for New Molecular Therapies
(MDPI, 2023-10-09) Isorna Retamino, Inmaculada; González Moles, Miguel Ángel; Muñoz, Miguel; Esteban Ortega, Francisco; Cirugía
In recent years, numerous approaches have been developed to comprehend the molecular alterations underlying thyroid cancer (TC) oncogenesis and explore novel therapeutic strategies for TC. It is now well established that the neurokinin-1 receptor (NK-1R) is overexpressed in cancer cells and that NK-1R is essential for the viability of cancer cells. The binding of substance P (SP) to NK-1R in neoplastic cells plays a pivotal role in cancer progression by promoting neoplastic cell growth, protecting tumor cells from apoptosis, triggering invasion and metastasis through the enhanced migration of cancer cells, and stimulating endothelial cell proliferation for tumor angiogenesis. Remarkably, all types of human TC (papillary, follicular, medullary, anaplastic), as well as metastatic lesions, exhibit the overexpression of SP and NK-1R compared to the normal thyroid gland. TC cells synthesize and release SP, which exerts its multiple functions through autocrine, paracrine, intracrine, and neuroendocrine processes, including the regulation of tumor burden. Consequently, the secretion of SP from TC results in increased SP levels in plasma, which are significantly higher in TC patients compared to controls. Additionally, NK-1R antagonists have demonstrated a dose-dependent antitumor action. They impair cancer cell proliferation on one side and induce apoptosis of tumor cells on the other side. Furthermore, it has been demonstrated that NK-1R antagonists inhibit neoplastic cell migration, thereby impairing both invasiveness and metastatic abilities, as well as angiogenesis. Given the consistent overexpression of NK-1R in all types of TC, targeting this receptor represents a promising therapeutic approach for TC. Therefore, NK-1R antagonists, such as the drug aprepitant, may represent novel drugs for TC treatment.
Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study
(Elsevier, 2023-05) Balakrishnan, Anita; Barmpounakis, Petros; Demiris, Nikolaos; Jah, Asif; Spiers, Harry V.M.; Talukder, Shibojit; OMEGA Study Investigators; Gómez Bravo, Miguel Ángel; Cirugía; CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
Research in context Evidence before this study Gallbladder cancer (GBC) is a rare malignancy worldwide for which there are no robust data to guide curative strategies. The benefits of operative intervention on survival from GBC, particularly more extensive resections, are uncertain. We searched PubMed from 1st January 1990 to 1st January 2022 for articles in English using the search term “gallbladder cancer”. There are no randomised trials or large prospective cohort studies assessing surgical outcomes from GBC. Retrospective studies using individual national cancer statistics lacked detail in important confounding factors such as comorbidities and types of operative intervention. Most studies featured small patient numbers or centred on high income countries (HICs), and little information was available on outcomes from low and middle income countries (LMICs). Moreover, conclusions from some studies were not consistent with current guidelines for operative intervention for GBC. Added value of this study This is the largest cohort study (n = 3676) examining the outcomes from surgical intervention for GBC, spanning 133 centres from 41 countries in HICs and LMICs and including regions with high and low incidence of GBC. Extensive resections (i.e., major hepatectomy, routine bile duct excision or resection of other organs) were associated with an excess risk of significant complications or death for 1 in 4 patients undergoing these procedures compared to cholecystectomy alone, with no associated improvement in overall survival. Higher tumour stage, nodal involvement and positive margins were associated with poorer prognosis. Liver resection showed no association with a survival benefit for the majority of GBC tumour stages and neoadjuvant and adjuvant treatments were poorly utilised across the whole cohort. Implications of all the available evidence Aggressive surgical approaches for GBC continue to be practiced globally against international consensus guidelines and without overall survival benefit. This contemporary study corroborates findings from previous small studies suggesting cholecystectomy alone is sufficient for most early stage tumours. Higher tumour stages and those with nodal involvement are unlikely to benefit from surgery given the likelihood of systemic disease, and should be considered for neoadjuvant treatment modalities. Current outcomes from surgical management of GBC in LMICs are broadly comparable to HICs. Multicentre studies via international collaborative research networks are needed to improve neoadjuvant and adjuvant management strategies and develop globally relevant guidelines to improve outcomes from GBC.
Criterios de ordenación temporal de las intervenciones quirúrgicas en patología cardiovascular y endovascular adquirida. Versión 2022
(Elsevier, 2023-01) Martín Gutiérrez, Elio; Castaño Ruiz, Mario; Hornero Sos, Fernando; Laguna Núñez, Gregorio; Barquero Aroca, José Miguel; Rodríguez-Roda Stuart, Jorge; Gutiérrez Carretero, Encarnación; Ortiz Berbel, Daniel; Cirugía; CTS1134: Investigación Traslacional en la Fisiopatología Cardiovascular
La gestión de las listas de espera de los diferentes sistemas de salud autonómicos para procedimientos de cirugía cardiaca constituye una importante preocupación entre los profesionales, de la que nuestra Sociedad científica no es ajena. En el año 2000 fue publicada la primera iniciativa de ordenación temporal de los pacientes con patología cardiovascular incluidos en lista de espera quirúrgica. Con los cambios en el manejo y en la concepción de algunas patologías, un nuevo marco normativo vigente y la coyuntura asistencial actual, se hace necesaria una revisión de los mencionados criterios para ofrecer una actualización adecuada al contexto clínico-asistencial presente. Por ello, se ha elaborado un documento basado en la revisión de la literatura científica disponible y en el consenso de un grupo de trabajo dentro de la Sociedad Española de Cirugía Cardiovascular y Endovascular, para actualizar en nuestro país las recomendaciones de prioridad de estas patologías en las listas de espera.
Tratamiento médico-quirúrgico de las infecciones en dispositivos de electroestimulación cardiaca
(Elsevier, 2023-06-19) Alarcón González, Arístides de; Ortiz Carrellán, Antonio José; Rezaei, Kambiz; Rodríguez Mora, Felipe; García de la Borbolla, Mariano; Gutiérrez Carretero, Encarnación; Cirugía; CTS1134: Investigación Traslacional en la Fisiopatología Cardiovascular
La terapia antibiótica en las infecciones de dispositivos implantables de electroestimulación cardiaca (DEC) debe ser siempre considerada como adyuvante a una extracción completa del dispositivo, única opción segura de lograr una curación completa. Sin embargo, en algunas infecciones locales puede ser exitosa de manera aislada y debe ser supervisada por un experto. En las infecciones sistémicas, el tratamiento antimicrobiano apropiado es imprescindible para evitar una sepsis grave y hacer posible la negativización pronta de los hemocultivos, lo que va a tener su importancia de cara al momento del recambio del sistema, una vez realizada la extracción completa del DEC. Finalmente, en los casos en los que no se puede retirar el dispositivo de forma completa, es preciso considerar el tratamiento oral supresivo.
Álvaro García Perla (1937-2022)
(Sociedad Española de Cirugía Oral y Maxilofacial (SECOMCyC), 2022) Infante Cossío, Pedro Antonio; Cirugía; CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial
Álvaro García Perla, una de las grandes figuras de la Cirugía Oral y Maxilofacial española y pionero de dicha especialidad en Andalucía, falleció a finales del mes de noviembre a la edad de 85 años. Nació en Algeciras (Cádiz) y su infancia transcurrió en el Protectorado de España en Marruecos (Tetuán), donde su padre ejercía como médico. El ejemplo paterno forjó su futuro como galeno, cursando sus estudios de medicina en la Universidad de Sevilla. (extracto)
Healthcare and Indirect Cost of the Laparoscopic vs. Vaginal Approach in Benign Hysterectomy
(Society of Laparoscopic & Robotic Surgeons, 2022-07) Martínez Maestre, María Ángeles; Jódar Sánchez, Francisco; Calderón Cabrera, Ana María; González Cejudo, Carmen; Silvan Alfaro, José Manuel; Melero Cortés, Lidia María; Cirugía
Background and Objectives: The aim of this study was to analyze indirect costs of vaginal and laparoscopic routes for hysterectomy to determine whether this makes a difference in total costs when considering route for surgery. Methods: A five-year observational retrospective cohort study was conducted in an academic tertiary care center. A total of 517 patients scheduled for total laparoscopic hysterectomy (n = 137) and vaginal hysterectomy (n = 380) for benign conditions between January 1, 2008 and December 31, 2012 meeting inclusion criteria were reviewed. Results: Indirect costs were higher in the vaginal hysterectomy group compared to the laparoscopic hysterectomy group (mean cost €3,239.86 vs. €1,371.58; cost increase of €1,868.28; p < .001). Indirect costs due to lost-work-productivity were the most important, represented by 97.7% in the vaginal group and 93.6% in the laparoscopic group. Conclusion: Among women undergoing hysterectomy for benign disease, laparoscopic hysterectomy appears to be superior to vaginal hysterectomy when indirect costs are analyzed in a five-year temporal horizon. Laparoscopic hysterectomy is a good alternative to vaginal hysterectomy when technically feasible as both present comparable advantages. The surgical approach to hysterectomy should be decided in light of the relative benefits and hazards, which will depend on clinical circumstances and surgical expertise.
Liver Resuscitation With Hypothermic Oxygenated Perfusion After Donation in Asystolic Type Iii With Regional Perfusion in Normothermia: A Case Report About First Experience in Spain
(Elsevier, 2022-11) Pueyo Périz, Eva María; Marín Gómez, Luis Miguel; Suárez Artacho, Gonzalo; Cepeda Franco, Carmen; Álamo Martínez, José María; Bernal Bellido, Carmen; Gómez Bravo, Miguel Ángel; Cirugía; CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
Background: Extended criteria donor livers are increasingly being accepted for transplant in an attempt to bridge the gap between the number of patients on the waiting list and the number of available donor livers. Our objective was to describe our first case of hepatic resuscitation by means of an ex situ perfusion machine in hypothermia with oxygen insufflation of a liver graft extracted from a donor in type 3 asystole after regional perfusion in normothermia. Methods: A 53-year-old woman with disabling polycystic liver disease was included on the liver transplant waiting list. Donation was offered in type 3 asystole with regional perfusion in normothermia. Given that it was an elderly donor with a low-weight graft, hepatic resuscitation was decided by means of an ex situ perfusion machine in hypothermia with oxygen insufflation. Results: After performing the bench work, the injector is selectively cannulated via the portal to connect it to the hypothermic perfusion machine. The average temperature of the perfusate (3 L modified Belzer) was 10°C for 120 minutes at 250 mL/min. The implant was completed without the need for transfusion of blood products, postreperfusion Sd, or vasoactive support. Peak of GOT/GPT was 803/276 at 24 hours posttransplant.
Multicriteria Decision Analysis for Updating of Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units in Spain
(Oxford University Press, 2022-05-11) Calvet, Xavier; Panés, Julián; Gallardo Escudero, Javier; Cuadra Grande, Alberto de la; Bartolomé, Elena; Marín, Laura; Portilla de Juan, Fernando de la; Barreiro de Acosta, Manuel; Cirugía
Background and Aims: Management of inflammatory bowel disease [IBD] is complex and IBD Comprehensive Care Units [ICCUs] facilitate the delivery of quality care to IBD patients. The objective of this study was to update the existing set of quality indicators [QIs] for ICCUs, based on a nationwide quality certification programme carried out in Spain, from a multi-stakeholder perspective and using multicriteria decision analysis [MCDA] methodology. Methods: An MCDA comprising three different phases was conducted. In phase 1, a systematic literature review was performed, and after validation by a scientific committee comprising 11 experts, a preliminary set of QIs was developed. In phase 2, a larger group of 49 experts determined the relevance and relative importance of each QI by prioritising and weighing the preliminary set. Finally in phase 3, the scientific committee reviewed the results and made a final selection via a deliberative process. Results: The final set comprised 67 QIs, classified as Structure [23 QIs], Process [35 QIs] and Outcome [9 QIs], which were ranked according to their relative importance. Multidisciplinary management was the most important requirement in ICCUs, followed by continuity of care, standardisation of clinical care and, especially, the incorporation of patients’ reported outcomes. Conclusions: This updated set of QIs comprises a weighted and prioritised set of items that represent the essential minimum of criteria for ensuring appropriate quality of care in the management of IBD patients.
Diferencia mínima clínica importante en calidad de vida relacionada con la salud
(Ministerio de Sanidad y Consumo, 2021-06-08) Rollón Mayordomo, Ángel; Rollón Ugalde, Virginia; López Jiménez, Ana María; Infante Cossío, Pedro Antonio; Cirugía; Psicología Experimental; CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial; SEJ066: Mujeres, Bienestar y Ciudadanía
Una de las limitaciones para el uso de los Cuestionarios de Calidad de Vida Relacionada con la Salud y de los resultados reportados por pacientes es la dificultad de interpretar los valores obtenidos. La diferencia mínima clínica importante es una medida que ayuda a comprender los resultados de estos cuestionarios y valorar la relevancia clínica del efecto conseguido por la intervención realizada. En este trabajo revisamos el concepto de diferencia mínima clínica importante, describimos los métodos utilizados para su obtención y exponemos sus dificultades, limitaciones y aplicabilidad. Dentro de los resultados reportados por pacientes y, particularmente, en los de calidad de vida, la diferencia mínima clínica importante es una herramienta que ayuda a los clínicos a utilizar correctamente las escalas de medida e interpretar el efecto de las intervenciones. Con este artículo esperamos facilitar la implantación y uso de la diferencia mínima clínica importante y los Cuestionarios de Calidad de Vida Relacionada con la Salud en la práctica habitual con nuestros pacientes.
Impact of Bacillus Calmette-Guérin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection
(Oxford University Press, 2022-01-08) Capitan-Morales, Luis-Cristobal; Toro López, María Dolores del; COVID Surg Collaborative; Cirugía
During the COVID-19 pandemic, multiple theories were proposed based on the observation that countries with an ongoing national Bacillus Calmette-Guérin (BCG) immunization programme had lower SARS-CoV-2 case rates and COVID-19 mortality than countries that had stopped BCG vaccine administration. There was, however, no evidence supporting or disputing this theory1,2. Owing to the uncertainty on the role of BCG vaccine on the outcomes of patients with perioperative SARS-CoV-2 infection, this international study aimed to determine whether previous BCG vaccination was associated with reduced postoperative pulmonary complications (PPC) and 30-day mortality in patients undergoing surgery who developed SARS-CoV-2 infection. (excerpt)
Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to laser pointer injury in a child
(Medknow Publications, 2021-07-02) Morillo Sánchez, María José; Llavero Valero, Pilar; Domínguez Serrano, Borja; Gómez Escobar, Antonio José; Gutiérrez Sánchez, Estanislao; Rodríguez de la Rúa Franch, Enrique; Cirugía
Laser pointers are readily available and are often labeled as toys. A 12-year-old girl was brought to the emergency department complaining of a central scotoma in the right eye after being exposed to a laser pointer. Fundus examination revealed severe maculopathy in both eyes. Optical coherence tomography angiography and fundus angiography examinations revealed choroidal neovascularization in the area of the laser injury in the right eye. One intravitreal anti-VEGF injection was administered in the right eye, resulting in good clinical and structural responses. Intravitreal anti-VEGF may be effective for improving visual outcomes in laser pointer-induced maculopathy complicated with choroidal neovascularization.
Sarcoma de pared torácica con resección en bloque de 6 arcos costales y reconstrucción con material protésico e injerto musculocutáneo
(Asociación de Neumología y Cirugía Torácica del Sur (Neumosur), 2021-07-21) Sánchez Matas, Carmen; Monge Blanco, Sara; García Gómez, Francisco; López-Villalobos, José Luis; Cruz Lozano, Francisco Javier de la; Blanco Orozco, Ana Isabel; Cirugía
Los sarcomas de pared torácica son un grupo raro de tumores originados en las células mesenquimales, con un comportamiento agresivo y tendencia a la diseminación a distancia. Pueden alcanzar grandes tamaños, lo que dificulta la resección quirúrgica que a día de hoy es el tratamiento de elección. Gracias a los materiales sintéticos y los injertos musculocutáneos, la extensión de la lesión y de la resección ya no supone una limitación para ofrecer al paciente un tratamiento quirúrgico.

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