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Abstract
Peritoneal tuberculosis is a rare form of tuberculosis, which involves parietal and visceral peritoneum, omentum, and intestinal mesentery. Its incidence is increasing in developed countries due to HIV infection and immigration. We present a case of peritoneal tuberculosis in a twenty two-year-old patient misdiagnosed with appendicitis. A laparoscopic surgery was performed showing multiple implants on serosal surfaces and adhesions. Laparoscopic appendectomy and peritoneal biopsies were performed. As peritoneal tuberculosis was suspected, an early antituberculous treatment was initiated. A pathological examination of the samples revealed epithelioid granulomas with a centrale caseous necrosis and acid-fast bacilli. Peritoneal tuberculosis is a challenging diagnosis that can mimic other pathologies and should be kept in mind to establish an early antituberculosis treatment avoiding the high morbidity and mortality associated with a late treatment initiation. In case of suspicion of peritoneal tuberculosis, laparoscopy with guided biopsies is useful for the establishment of a correct diagnosis.
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Affiliation(s)
- Elena Viejo Martínez
- Department of Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - María García Nebreda
- Department of Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | | | - Gloria Paseiro Crespo
- Department of Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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Pérez Zapata AI, Rodríguez Cuéllar E, de la Fuente Bartolomé M, Martín-Arriscado Arroba C, García Morales MT, Loinaz Segurola C, Giner Nogueras M, Tejido Sánchez Á, Ruiz López P, Ferrero Herrero E, Zarco Pleguezuelos A, Romero Simó M, Caballero Bouza A, Parés Martinez D, Julián Ibáñez JF, Balibrea del Castillo JM, Morales Sevillano X, Díaz-Zorita Aguilar B, Martín Román L, Gomez Ruiz M, Fernández Miguel T, Cagigas Fernandez C, Moreno Bargueiras A, Cano Valderrama O, Alonso Rivera D, Gutiérrez Samaniego M, Elia Guedea M, Córdoba Diaz E, Gracia Solanas JA, Bañuls Matoses A, Macero Á, Sánchez López JD, Vaquero Pérez MA, Rojo López JA, Lima Pinto F, Bra Insa E, Rodríguez Prieto I, Padilla Zegarra ED, Franco Chacon M, Memba Ikuga R, Jorba Martin R, Alcaide Matas F, Troncoso Pereira P, Soria Aledo V, Pérez Guarinos CV, Genzor Rios S, Dobón Rascón MÁ, Núñez Fernández S, Valerias Domínguez E, García García M, Zambrana Campos V, Rebasa Cladera P, Artés Caselles M, Cea Soriano M, Gambí Pisonero D, Jiménez de los Galanes S, Frutos Bernal MD, Delegido García A, Gómez Pérez B, Montero Zorrilla C, Cortés Climent J, Vallejo Bernad C, Bustamante Mosquera R, Blázquez M, Muriel López J, García Pérez JC, Ocaña Jiménez J, Paseiro Crespo G, Pardo Martínez C, García Nebreda M, Fernández Cebrián JM, Casanova Durán V, Ferrer Márquez M, Aguiló Lucía J. Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study. Patient Saf Surg 2022; 16:7. [PMID: 35135570 PMCID: PMC8822669 DOI: 10.1186/s13037-021-00316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/19/2021] [Indexed: 11/11/2022] Open
Abstract
Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.
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Loinaz Segurola C, Ochando Cerdán F, Vicente López E, Serrablo Requejo A, López Cillero P, Gómez Bravo MÁ, Fabregat Prous J, Varo Pérez E, Miyar de León A, Fondevila Campo C, Valdivieso López A, Blanco Fernández G, Sánchez B, López Andújar R, Fundora Suárez Y, Cugat Andorra E, Díez Valladares L, Herrera Cabezón J, García Gil A, Morales Soriano R, Pardo Sánchez F, Sabater Ortí L, López Baena JÁ, Muñoz Bellvís L, Martín Pérez E, Pérez Saborido B, Suárez Muñoz MÁ, Meneu Día JC, Albiol Quer M, Sanjuanbenito Dehesa A, Ramia Ángel JM, Pereira Pérez F, Paseiro Crespo G, Palomo Sánchez JC, León Sanz M. Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain. NUTR HOSP 2020; 37:238-242. [PMID: 32090583 DOI: 10.20960/nh.02895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: a survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (< 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country.
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García Nebreda M, Paseiro Crespo G, Álvaro Cifuentes E, Marqués Medina E, Burdaspal Moratilla A. Gastric duplication cyst with respiratory epithelium: An uncommon injury that has a difficult diferential diagnosis. Cir Esp 2018; 97:57-59. [PMID: 30072026 DOI: 10.1016/j.ciresp.2018.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 11/26/2022]
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Paseiro Crespo G, Nebreda MG, Barceló López M, Marqués Medina E, Gimeno Aranguez M. Verrucous carcinoma of the esophagus: A rare entity with a difficult diagnosis. Cir Esp 2018; 96:453-455. [PMID: 29452967 DOI: 10.1016/j.ciresp.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/14/2017] [Accepted: 11/25/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Gloria Paseiro Crespo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
| | - María García Nebreda
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
| | - Marta Barceló López
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
| | - Elia Marqués Medina
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
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Paseiro Crespo G, García Nebreda M, Marqués Medina E, Álvaro Cifuentes E. Cystic duct cyst lesions (type VI). Rev Esp Enferm Dig 2017; 109:373. [PMID: 28480726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Todani proposed the most accepted classification for cystic lesions of the bile duct, including 5 types. Serena described another one, type VI, which includes cystic lesions of the isolated cystic duct, of which there are less than twenty reported cases. They differ from type II in terms of the distal cystic caliber, which is normal in type VI, and in the diagnosis which is performed intra-operatively in most of the cases. Neoplastic degeneration has an incidence of 10 to 30% in all these lesions, which is the reason why the most widely accepted treatment is cholecystectomy with resection of the cystic duct cyst dilatation and preservation of the main bile duct by a laparoscopic approach.
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Affiliation(s)
| | - María García Nebreda
- Servicio de Cirugía General y Digestivo, Hospital Universitario Infanta Leonor, España
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Durán Giménez-Rico H, Abril Vega C, Herreros Rodríguez J, Concejo Cútoli P, Paseiro Crespo G, Sabater Maroto C, Jadraque Jiménez P, Durán Sacristán H. Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery. Clin Transl Oncol 2006; 7:306-13. [PMID: 16185593 DOI: 10.1007/bf02710270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). MATERIAL AND METHODS A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. RESULTS Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). CONCLUSIONS Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk.
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