Artículos (Cirugía)

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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 Sevilla
Objective 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.
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 Cirugía
Pancreatic 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.
Artificial intelligence to determine correct midsagittal plane in dynamic transperineal ultrasound
(Wiley, 2025-04-25) García Mejido, José Antonio; Galán Páez, Juan; Solís Martín, David; Martín Morán, Marina; Borrero González, Carlota; Fernández-Gómez, Alfonso; Fernández Palacín, Fernando; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Ciencias de la Computación e Inteligencia Artificial; Agencia Estatal de Investigación. España; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Universidad de Sevilla. TIC137: Lógica, Computación e Ingeniería del Conocimiento
Purpose: To create and validate a machine learning(ML) model that allows for identifying the correct capture of the midsagittal plane in a dynamic ultrasound study, as well as establishing its concordance with a senior explorer and a junior explorer. Methods: Observational and prospective study with 90 patients without pelvic floor pathology. Each patient was given an ultrasound video where the midsagittal plane of the pelvic floor was recorded at rest and during the Valsalva maneuver. A segmentation model was used that was trained on a previously published article, generating the segmentations of the 90 new videos to create the model. The algorithm selected to build the model in this project was XGBoost(Gradient Boosting). To obtain a tabular dataset on which to train the model, feature engineering was carried out on the raw segmentation data. The concordance of the model, of a junior examiner and a senior examiner, with the expert examiner was studied using the kappa index. Results: The first 60 videos were used to train the model and the last 30 videos were reserved for the test set. The model presented a kappa index 0.930(p < 0.001) with very good agreement for detection of the correct midsagittal plane. The junior explorer presented a very good agreement (kappa index = 0.930(p < 0.001)). The senior explorer presented a kappa index 0.789(p < 0.001) (good agreement) for detection of the correct midsagittal plane. Conclusion: We have developed a model that allows determining the correct midsagittal plane captured through dynamic transperineal ultrasound with a level of agreement comparable to or greater than that of a junior or senior examiner, using expert examiner assessment as the gold standard.
Oral vs. outpatient parenteral antimicrobial treatment for infective endocarditis: study protocol for the spanish oralPAT‑IE GAMES Trial
(Springer London Ltd, 2025-03-01) Cuervo, Guillermo; Hernández-Meneses, Marta; Alarcón, Arístides de; Luque-Marquez, Rafael; Alonso-Socas, María M.; López-Lirola, Ana; López-Cortes, Luis Eduardo; de Cueto López, Marina; OraPAT-IE GAMES Investigators; Araji Tiliani, Omar; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Cirugía
Introduction The POET trial demonstrated that moving from intravenous to oral antibiotics in stable patients with left-sided infective endocarditis (IE) was noninferior to fully parenteral treatment. However, it did not compare outpatient strategies. Methods The OraPAT-IE GAMES trial is a noninferiority, multicenter, randomized, open-label study aimed to compare partial oral versus outpatient parenteral antibiotic therapy (OPAT) for consolidation of antibiotic treatment in left-sided IE. A total of 342 stable patients with IE caused by selected micro-organisms will eventually be included. After a minimum of 10 days of parenteral treatment, stable patients are randomized to oral therapy or OPAT. The primary end-point is a composite of all-cause mortality, unplanned cardiac surgery, relapse of positive blood cultures and/or unplanned hospital admission. Patients are followed-up for 6 months after completing antibiotic therapy. Planned Outcome This trial seeks to demonstrate the equivalent efficacy of the two outpatient strategies currently available for stable patients with IE in the consolidation phase of antibiotic treatment. Conclusion In a global context of limited healthcare resources and a sustained increase in elderly and frail patients, it is of great importance to demonstrate the effectiveness and safety of outpatient management strategies that could reduce the duration of conventional hospitalizations with their potential complications and inherent costs.
Pneumocystis infection in pregnant women: a scoping review
(MDPI, 2025-04-25) Calderón-Baturone, Irene; Salsoso, R; Charpentier, Eléna; de Armas, Yaxsier; Guadix, Pilar; Morilla Romero de la Osa, Rubén; Friaza, Vicente; Calderón Sandubete, Enrique José; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Enfermería; Universidad de Sevilla. Departamento de Medicina; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS607: Salud Reproductiva de la Mujer
Pneumocystis jirovecii is an opportunistic fungus that causes severe pneumonia in immunosuppressed individuals. While Pneumocystis colonization, a subclinical form of infection, has been studied in different populations, its implications during pregnancy remain poorly understood. Given the immune modulation of pregnancy, maternal colonization or infection may contribute to vertical transmission and neonatal respiratory complications. This scoping review aims to map the existing evidence on Pneumocystis colonization/infection during pregnancy, identifying knowledge gaps, prevalence, risk factors, and potential neonatal outcomes. A systematic literature search was conducted in three databases following PRISMA-ScR guidelines. A total of 26 studies were included, covering Pneumocystis pneumonia cases (n = 19) and Pneumocystis colonization (n = 7). The review found that most Pneumocystis pneumonia cases in pregnant women were associated with HIV before antiretroviral therapy. More recent cases were related to hematologic malignancies. Pneumocystis colonization rates varied widely (5.4–46.5%). Evidence of vertical transmission was observed, but neonatal impact remains underexplored. This review highlights the need for HIV screening in pregnant women and the need to include Pneumocystis in the diagnosis of pregnant women with pneumonia. Increased awareness and research on Pneumocystis in pregnancy are necessary to improve maternal and neonatal outcomes. Future studies should focus on vertical transmission and neonatal respiratory health.
What type of terminology should be applied to define levator ani muscle avulsion?
(Wiley, 2025-04-18) García Mejido, José Antonio; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía
The avulsion of the levator ani muscle (LAM) occurs during vaginal delivery1 and is associated closely with future pelvic floor dysfunction, such as pelvic organ prolapse. Due to the clinical relevance of LAM avulsion in the development of pelvic floor disorders, there has been an increase in the number of publications examining its progression over time. However, recent publications based on ultrasound studies have defined LAM avulsion using different terminologies, relying on either anatomical or purely ultrasound-based criteria2–4, without establishing which definition is the most appropriate. Therefore, our objective was to justify how LAM avulsion diagnosed in an ultrasound study should be defined. (extract)
Head and neck cancer. an aetiopathogenetic study of non-endemic lymphoepithelioma
(Pacini Editore Medicina, 2013-03) Casco, F.G.; Ríos, M.J.; Miguel Rodríguez, Manuel de; González, T.; Moreno-Fernández, Ana María; Galera Ruiz, Hugo; González Campora, Ricardo; Drut, R.; Bacchi, C.; Galera Davidson, Hugo; Universidad de Sevilla. Departamento de Citología e Histología Normal y Patológica; Universidad de Sevilla. Departamento de Cirugía
An aetiopathogenetic analysis of non-endemic nasopharyngeal carcinoma (NPC) in European and Southern American patient groups was performed. Specifically, the study sought to determine the proportion of Epstein-Barr Virus (EBV)-positive tumour cells in NPC patients in two very different populations (Europe and South America) in areas not associated with a high incidence of NPC. Clinical data (age, sex and onset of clinical disease) were also analyzed. A total of 50 NPC samples, 24 from a European hospital (EH) and 26 from two South American hospitals (SAH), were included. Nuclear staining for Epstein-Barr virus–encoded small RNA (EBER) was performed by in situ hybridization (ISH). Latent membrane protein 1 (LMP1) expression was measured by immunohistochemical (IHC) analysis. A higher incidence of NPC was observed in patients > 40 years of age in EH; in SAH, by contrast, the incidence was higher in patients aged ≤ 40 years. Cervical lymph node metastasis was detected in 31 patients (of whom 84.6% were from SAH). A total of 72% of samples were EBERpositive; the incidence of EBER positivity was greater in type 3 NPCs. EBV was detected in a large proportion of epithelial cells in samples from both EH and SAH (75% vs. 69.2%, respectively). An association was found between EBER detection in lymphocytes and patient origin (p = 0.0001). LMP1 expression was detected in 64% of patients. ISH for the detection of EBER is the most sensitive technique for demonstrating EBV in tumour tissue. The incidence of EBV was not significantly greater in either of the study populations, but was significantly higher in patients with type 3 NPC. Definitive histological diagnosis of NPC was reached earlier in EH than in SAH, where metastases were more frequently diagnosed, suggesting that the disease had reached a more advanced stage by the time treatment was started
Efficacy and Safety of Celiac Plexus Neurolysis in the Treatment of Chronic Pain Secondary to Oncological Pathology of the Upper Hemiabdomen: A Systematic Review and Meta-Analysis
(Indian Association of Palliative Care, 2023) Pacheco-Feijoó, Gloria Melissa; Amado-Tineo, José Percy; Plancarte-Sánchez, Ricardo; Valdivia, Carlos Contreras; López Millán, José Manuel; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment to determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control (P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.
Prótesis unicompartimental como opción quirúrgica en la gonartrosis medial en el adulto joven
(Elsevier Doyma, 2012-12-11) José Francisco Lirola Criado; Tejero García, Sergio; Serrano Toledano, David; Martínez Salas, José Manuel; Borrego Paredes, Estrella; Domecq Fernández de Bobadilla, Gabriel; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
OBJETIVO: Valorar el grado de satisfacción de una serie de pacientes con edades comprendidas entre 50 y 60 años intervenidos en nuestra unidad de prótesis unicompartimental (PUC) por gonartrosis monocompartimental, así como la definición basada en la literatura actual, nuestra experiencia en las indicaciones, contraindicaciones y resultados de la artroplastia unicompartimental interna de rodilla discutidas con la osteotomía tibial supratuberositaria, opción quirúrgica mas usual en estos casos. MATERIAL Y MÉTODO: Se incluyen en el estudio 19 pacientes, de entre 50 y 60 años (media de 56,7) (Intervalo de 51-60 años) intervenidos entre 7/2007 y 11/2011 por un mismo cirujano (GDFB). Valoración funcional y aplicando el cuestionario Oxford Knee Score (OKS). Se ha realizado una búsqueda bibliográfica en las bases de datos MEDLINE, COCHRANE y EMBASE desde 1988 a 2012. RESULTADOS: Con un seguimiento medio de 29,4 meses, 16 de los 19 pacientes refieren estar satisfechos con el resultado obtenido y volverían a intervenirse. Un paciente sufrió infección protésica y se revisó a PTR, con buenos resultados. CONCLUSIONES: la artroplastia unicompartimental medial de rodilla es una opción quirúrgica valida y reproducible en el tratamiento a medio plazo de la gonartrosis monocompartimental en pacientes con edades comprendida entre 50 y 60 años.
Use of a new expansive screw in patients with poor bone quality. Multicenter study
(Sociedade Brasileira de Coluna, 2013-22) Rovira Gutiérrez, Manuel; Fernández González, Manuel; Villar Pérez, Julio; Pérez Varela, Luis; Hernández Pascua, Luis; Alia Benítez, José; Domínguez Ignacio, Esteban; Quintana Cruz, Jose Jaime; Zúñiga Gomez, Lorenzo; Izquierdo Nuñez, Enrique; Universidad de Sevilla. Departamento de Cirugía
OBJECTIVE: To observe the behavior of the expansive screw in patients with poor bone quality, its safety, the technique, conduct and complications: percentage of loosening, breaks, pull-outs and pseudoarthrosis. METHODS: Prospective multicenter study analyzing the patient’s risk factors, VAS, surgery time, blood loss, location of the screws and complications due to the implant at the time of discharge, and at 3, 12 and 24 months. RESULTS: 99% of the patients did not have any permanent complications related to the implant; there was only one case of unresolved radiculopathy. In 95% of the implants, the screws were placed without complications; in 5% percent of cases there were complications related to poor placement or expansion of the screw, which were resolved with the surgery. Mean intervention time per level: 56 minutes; average intervention time, 2 hours and 35 min. Average bleeding per level that received intervention, 211cc. There were three cases of "pull-out". VAS evolved favorably and significantly, with average reduction greater than four points. The study will continue until age five, these being the preliminary results. CONCLUSIONS: This type of expansive screw provides a new anchoring system for patients with poor bone quality; it is safe and effective, easy to insert, and provides less exposure to X-ray, and in case of removal of the screw, it leaves the way free for a new surgery.
Análisis del síndrome inestable-doloroso de la articulación subastragalina mediante el sistema estrés dinámico baropodoTAC
(Sociedad Andaluza de Traumatología y Ortopedia (SATO), 2013) Tejero García, Sergio; Lirola Criado, J.F.; Giráldez Sánchez, Miguel Ángel; Cano Luis, Pedro; Navarro Robles, A.; Carranza Bencano, Andrés; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Introducción: La inestabilidad de tobillo y de retropié coexisten frecuentemente sin que existan en la actualidad métodos objetivos no quirúrgicos para su diagnóstico diferencial. Además, la inestabilidad y el dolor en la articulación subastragalina pueden desembocar en la temida artrosis de retropié en pacientes de cualquier edad. El presente trabajo tiene como propósito principal comparar el rango de movilidad del retropié sintomático respecto al retropié sano en una serie consecutiva de pacientes afectos de inestabilidad de tobillo. Material y Método: Se diseñó un dispositivo que simula condiciones de carga con movimientos extremos de la articulación subastragalina sobre la mesa de TAC (Estrés-BaroPodo-TAC). Se realizó TAC en carga y en dos posiciones extremas de inversión-rotación interna y eversión-rotación externa sobre 26 pies de 13 pacientes diagnosticados de inestabilidad crónica de tobillo. Se midieron los ángulos de divergencia y "exión astrágalo-calcánea en las dos posiciones mencionadas y se calculó el rango de movimiento total. Se comparó el retropié problema con el retropié sano en cada paciente. Resultados: Los pies problemas presentaron mayor rango de movilidad de divergencia astrágalo-calcáneo que los pies sanos de los pacientes. No hubo diferencias en el rango de movilidad de flexión astrágalo-calcáneo. No se correlacionó estadísticamente el movimiento de divergencia en el plano axial con el movimiento de flexión astrágalo-calcánea en el plano sagital. Conclusión: Mediante este método se midió objetivamente mediante TAC el rango de movimiento de la articulación subastragalina. Los pacientes con inestabilidad de tobillo y dolor en retropié presentaron mayor rango de movilidad en la articulación subastragalina en el retropié doloroso respecto al contralateral.
Management of ankle charcot neuroarthropathy: A systematic review
(MDPI, 2021-12-17) Galhoum, Ahmed Elsayed; Trivedi, Vineet; Askar, Mohamed; Tejero García, Sergio; Herrera-Pérez, Mario; Alrashidi, Yousef; Valderrabano, Victor; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Background: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. Methods: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. Results: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. Conclusions: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.
Conservative treatment of ankle osteoarthritis
(MDPI, 2021-09-30) Tejero García, Sergio; Prada-Chamorro, Estefanía; González-Martín, David; García-Guirao, Antonio Jesús; Galhoum, Ahmed E.; Valderrabano, Victor; Herrera-Pérez, Mario; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Despite the disabling nature of ankle osteoarthritis (OA), there is poor scientific evidence for a conservative treatment compared to the hip and knee OA. In this regard, most of the treatment options in use are not based on clinical studies of the ankle, and they are extracted from evidence obtained from clinical studies of other lower limb joints. However, this does not seem to be a good idea, since the aetiology of ankle OA is quite different from that of the hip or knee. Nonpharmacological and pharmacological treatments such as nonsteroidal anti-inflammatory drugs, hyaluronic acid, corticosteroid, platelet-rich plasma injection and mesenchymal stem cells injections have been reported. However, further research is required in this field to obtain a specific clinical practice guideline for the conservative treatment of ankle OA.
Ankle osteoarthritis aetiology
(MDPI, 2021-09-29) Herrera-Pérez, Mario; González-Martín, David; Vallejo-Márquez, Mercedes; Godoy-Santos, Alexandre L.; Valderrabano, Victor; Tejero García, Sergio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Ankle osteoarthritis affects 1% of the population and, unlike gonarthrosis or coxarthrosis, is secondary to previous trauma in more than 75% of cases. Another peculiarity of this disease is that it affects a younger and active population, with socio-occupational implications. Mechanical factors, such as incongruity, instability, malalignment, and impacts, which increase stress on isolated areas of the ankle cartilage, have been clearly associated with the development of osteoarthritis. However, we cannot ignore the importance of pro-inflammatory mediators present from the moment of fracture as triggers of the cascade that eventually causes chondrocyte cell death, ultimately responsible for ankle osteoarthritis.
Tibiotalocalcaneal nailing for osteoporotic ankle fractures in the frail patient: a narrative review with a clinical score proposal for the decision-making process
(Bioscientifica LTD, 2022) Martín-Vélez, Pablo; González-Martín, David; Domínguez-Meléndez, Miguel; Galhoum, Ahmed E.; Valderrabano, Victor; Tejero García, Sergio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Osteoporotic ankle fractures result from mechanical forces that would not ordinarily result in fracture, known as ‘low-energy’ trauma, such as those equivalent to a fall from a standing height or less. Osteoporotic ankle fractures in frail patients are becoming more and more frequent in daily practice and represent a therapeutic challenge for orthopaedic surgeons. The main problems with frail patients are the poor condition of the soft tissues around the ankle, dependence for activities of daily living and high comorbidity. The decision to operate on these patients is complex because conservative treatment is poorly tolerated in unstable fractures and conventional open reduction and internal fixation is associated with a high rate of complications. The authors conducted a narrative review of the literature on primary tibiotalocalcaneal nailing of ankle fractures in frail patients and categorized the different factors to consider when treatment is indicated for this conditon. Difficulty of ambulation, age over 65 years old, deteriorated baseline state and instability of the fracture were the most frequently considered factors. Finally, the authors propose an easy and quick clinical scoring system to help in the decision-making process, although further comparative studies are required to explore its validity.
Intraoperative liquid biopsy as a tool for detecting R1 resection during pancreatoduodenectomy in patients with pancreatic carcinoma: the CETUPANC trial (part II)
(Elsevier Ltd.; Elsevier; Lippincott Williams & Wilkins, 2024-11-15) Padillo Ruiz, Francisco Javier; García, Carlos; Suárez Artacho, Gonzalo; Blanco, Gerardo; Muñoz-Bellvis, Luis; Justo, Iago; Álamo Martínez, José María; Gómez Bravo, Miguel Ángel; Tinoco González, José; Sabater, Luis; Universidad de Sevilla. Departamento de Cirugía; Instituto de Salud Carlos III; Universidad de Sevilla. CTS664: Cirugía Avanzada y Trasplantes. Terapia Celular y Bioingeniería Aplicada a la Cirugía
Introduction: A positive surgical margin (R1 resection) is a relevant risk factor for local recurrence in patients with pancreatic ductal adenocarcinoma of the pancreas (PDAC). An intraoperative liquid biopsy (ILB) based on tumor cell mobilization could help to detect R1 resection intraoperatively. Objective: To evaluate the potential role of the intraoperative circulating tumor cells (CTCs) and cluster mobilization on the R0/R1 detection. Methods: Sixty-three patients with resectable PDAC of the head of the pancreas were prospective enrolled under the CETUPANC trial. Open pancreaticoduodenectomy (PD) was done in all patients. Intraoperative CTCs and clusters were determined during PD. Results: The overall rate of R1 resection was 34.9% (22/63 patients). Multivariate analysis showed that factors associated with R1 resection (AUC=0.920) were the presence of undifferentiated G3 tumor (P=0.017), microscopic vascular invasion (P =0.016), and the intraoperative increase of both free CTCs and clusters in portal vein determination from the beginning to the end of the surgery (P=0.002 and P=0.005, respectively). A specific logistic regression model, including delta end to baseline CTCs and cluster mobilization to achieve a combined cut-off to detect R1 detection was calculated (AUC=0.799). The obtained R1-index based on ILB had 84% of sensitivity and 68% of specificity to detect R1 resection. Conclusions: The ILB based on the intraoperative mobilization of CTCs and clusters from the beginning to the end of the PD was a predictive factor to detect R1 resection in patients with PDAC.
Joint-preserving surgery in varus ankle osteoarthritis
(MDPI, 2022-04-14) Alajlan, Ahmad; Santini, Simone; Alsayel, Faisal; Teoh, Kar H.; Alharbi, Waheeb; Puls, Luise; Tejero García, Sergio; Valderrabano, Victor; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.
Geminación dental: Presentación de un caso
(Medicina Oral, S. L., 2002-06) Hernández Guisado, José María; Torres-Lagares, Daniel; Infante Cossío, Pedro Antonio; Gutiérrez Pérez, José Luis; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Cirugía; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS523: Innovación y Desarrollo en Técnicas y Fundamentos de Cirugía Bucal y Craneofacial; Universidad de Sevilla. CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial
Las anomalías dentales pueden ser clasificadas en distintos grupos: anomalías de volumen, anomalías de número, anomalías de forma, anomalías de posición y anomalías por unión. Dentro de las últimas distinguimos entre fusión, geminación, concrescencia, coalescencia y anquilosis alvéolo-dentarias. La geminación es más frecuente en los dientes anteriores, aunque también puede afectar a premolares y molares, siendo una anomalía por unión infrecuente (prevalencia 0,5%). Presentamos el caso de un joven de 19 años sin antecedentes médicos de interés que acude a consulta por repetidos accidentes inflamatorios a nivel de la zona retromolar inferior izquierda. Estos episodios tienen su causa en un tercer molar inferior semi-incluido que se encuentra unido a un cuarto molar inferior supernumerario compartiendo raíz, corona, cámara y conductos pulpares. Tras el estudio radiológico oportuno y la planificación adecuada, el cordal semi-incluido fue extraído bajo anestesia local sin que se produjeran otras complicaciones durante o tras la intervención quirúrgica.
Inestabilidad sutil de la sindesmosis tibioperonea: diagnóstico mediante TAC con carga axial y posiciones forzadas del pie
(Elsevier Doyma, 2022-06-07) Juan Chans Veres; Antonio García-Guirao; Tejero García, Sergio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. CTS972: Análisis Biológico y Funcional del Ejercicio Físico
Objetivo Probar un método diagnóstico objetivo, fiable y reproducible que permita detectar la inestabilidad sutil de la sindesmosis tibioperonea. Material y métodos Se presenta el caso de un paciente con dolor recurrente sobre la articulación tibioperonea tras un esguince de tobillo. Ante la sospecha de lesión de los ligamentos tibioperoneos se realizó un TAC con carga axial y posiciones forzadas de ambos pies. Resultados La diferencia en el área del espacio tibioperoneo entre la posición de relajación y la posición de tensión de la sindesmosis en el tobillo sano fue de 5,79 mm2, mientras que en el tobillo lesionado fue de 22,58 mm2. Conclusión El TAC con carga axial y posiciones forzadas de ambos pies puede ser útil para el diagnóstico de la inestabilidad sutil de la sindesmosis tibioperonea.
Tumor odontogénico epitelial calcificante (tumor de Pindborg)
(Medicina Oral S. L., 2002-10) Belmonte Caro, Rodolfo; Torres-Lagares, Daniel; Mayorga Jiménez, Francisco; García-Perla García, Alberto; Infante Cossío, Pedro Antonio; Gutiérrez Pérez, José Luis; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Cirugía; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS523: Innovación y Desarrollo en Técnicas y Fundamentos de Cirugía Bucal y Craneofacial; Universidad de Sevilla. CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial
En este artículo presentamos y discutimos el caso clínico de una paciente de 41 años afecta de un tumor de Pindborg que asentaba en el ángulo mandibular izquierdo. La detección de la lesión de forma casual o rutinaria y la frecuente relación que ésta tiene con un diente incluido pueden hacer difícil la diferenciación principalmente con un quiste odontogénico. Pese a la existencia de una tasa de recurrencias del 14% tras un tratamiento conservador, pensamos que un tratamiento de calidad exige la práctica de una exéresis de la lesión con márgenes óseos sanos.

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