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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Peña EÁ, Garcia-Botella A, Martín-Pérez E, Gallego MÁ, Cortijo SM, Migueláñez IP, Díaz LP, Ramos Rodríquez JL, Espín-Basany E, Santos RS, Garriga XG, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cirugía Española (English Edition) 2021. [PMCID: PMC7901494 DOI: 10.1016/j.cireng.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals’ safety.
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Álvarez Peña E, Garcia-Botella A, Martín-Pérez E, Álvarez Gallego M, Martínez Cortijo S, Pascual Migueláñez I, Pérez Díaz L, Ramos Rodríquez JL, Espín-Basany E, Sánchez Santos R, Guirao Garriga X, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cir Esp 2021; 99:174-182. [PMID: 33341242 PMCID: PMC7744030 DOI: 10.1016/j.ciresp.2020.10.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/30/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.
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Affiliation(s)
| | - Miguel Angel Gómez Bravo
- Cirugía general y del aparato digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Marcello Di Martino
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Mikel Gastaca
- Cirugía general y del aparato digestivo, Hospital Universitario Cruces, Bilbao, España
| | - Elena Martín-Pérez
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Santiago Sánchez Cabús
- Cirugía general y del aparato digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Santiago López Ben
- Cirugía general y del aparato digestivo, Hospital Dr. Josep Trueta, Girona, España
| | | | - Rafael López-Andújar
- Cirugía general y del aparato digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Manuel Barrera
- Cirugía general y del aparato digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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Morales-Conde S, Balla A, Álvarez Gallego M, Aranda Narváez JM, Badia JM, Balibrea JM, García-Botella A, Guirao X, Espín-Basany E, Martín-Antona E, Pérez EM, Martínez Cortijo S, Pascual Miguelañez I, Pérez Díaz L, Ramos Rodríguez JL, Rubio Pérez I, Sánchez Santos R, Soria-Aledo V. A dynamic scale for surgical activity (DYSSA) stratification during the COVID-19 pandemic. Br J Surg 2020; 107:e425-e426. [PMID: 32735347 PMCID: PMC7929180 DOI: 10.1002/bjs.11870] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital QuironSalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Sevilla, Spain
| | - Mario Álvarez Gallego
- Department of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Josep María Badia
- Unit of General and Digestive Surgery, Hospital General de Granollers, Barcelona, Spain
| | - José María Balibrea
- Department of Gastrointestinal Surgery (ICMDiM), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alejandra García-Botella
- HBP Surgery Unit. Derpartment of General and Digestive Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Xavier Guirao
- Unit of Endocrine and Head and Neck Surgery.Department of General and Digestive Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Esteban Martín-Antona
- HBP Surgery Unit. Derpartment of General and Digestive Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Martín- Pérez
- Unit of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Lola Pérez Díaz
- Unit of General and Digestive Surgery, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Inés Rubio Pérez
- Department of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Victor Soria-Aledo
- Servicio de Cirugía General, Hospital Morales Meseguer, Universidad de Murcia, Campus Mare Nostrum, Murcia, Spain
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Balibrea JM, Badia JM, Rubio Pérez I, Martín Antona E, Álvarez Peña E, García Botella S, Álvarez Gallego M, Martín Pérez E, Martínez Cortijo S, Pascual Miguelañez I, Pérez Díaz L, Ramos Rodriguez JL, Espin Basany E, Sánchez Santos R, Soria Aledo V, López Barrachina R, Morales-Conde S. Surgical Management of Patients With COVID-19 Infection. Recommendations of the Spanish Association of Surgeons. Cirugía Española (English Edition) 2020. [PMCID: PMC7196403 DOI: 10.1016/j.cireng.2020.04.003] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required.
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Affiliation(s)
- Jose M. Balibrea
- Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Josep M. Badia
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
- Corresponding author.
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Balibrea JM, Badia JM, Rubio Pérez I, Martín Antona E, Álvarez Peña E, García Botella S, Álvarez Gallego M, Martín Pérez E, Martínez Cortijo S, Pascual Miguelañez I, Pérez Díaz L, Ramos Rodriguez JL, Espin Basany E, Sánchez Santos R, Soria Aledo V, López Barrachina R, Morales-Conde S. Surgical Management of Patients With COVID-19 Infection. Recommendations of the Spanish Association of Surgeons. Cir Esp 2020; 98:251-259. [PMID: 32252979 PMCID: PMC7270428 DOI: 10.1016/j.ciresp.2020.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required.
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Affiliation(s)
- Jose Mose Balibrea
- Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Josep Mose Badia
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España.
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Abstract
PURPOSE To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered. METHODS A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy. RESULTS All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE +/- 4.6). CONCLUSIONS The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.
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Affiliation(s)
- I T Pinto Pabón
- Vascular and Interventional Radiology Department, Hospital Universitario de Getafe, Ctra de Toledo km. 12,500, E-28905 Getafe, Madrid, Spain.
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Abstract
PURPOSE To assess technical problems related to implantation of a polyurethane stent to treat obstructive epiphora, and to assess the long-term patency of the nasolacrimal system. MATERIALS AND METHODS Fluoroscopically guided placement of a polyurethane nasolacrimal stent was performed in 70 obstructed lacrimal systems of 62 patients with grade 3-4 obstructive epiphora. Follow-up was conducted for 1-20 months (average, 11.3 months). The obstruction was at the lacrimal sac in six systems, at the junction between the lacrimal sac and the nasolacrimal duct in 60 systems, and at the nasolacrimal duct in four systems. The cause of the obstruction was idiopathic in all cases but was probably residual to dacryocystitis. RESULTS Of these 70 procedures, stent placement was technically successful in 61 systems (87%). On long-term follow-up, 41 (67.2%) stents remained in place, with resolution or clinical improvement, and 18 (29.5%) stents were removed (because of occlusion in 17 systems), with stent malpositioning in the duct in six cases. There were seven cases of malpositioning in all. Statistical analysis was performed to evaluate patency, compare patency in properly positioned stents and malpositioned stents, and establish the relationship between malpositioning and the need for irrigation to maintain stent patency. Of the total 70 stents originally placed, 41 (58.6%) were still in place and functional at long-term follow-up. At 1 year, 73% of properly positioned stents remained patent versus 0% of improperly positioned stents. Median stent patency in the former group was 20 months and was 1 month in the latter group (P = .00002). Eleven percent of properly positioned stents required irrigation versus 57% of incorrectly positioned stents (P = .01). CONCLUSION After follow-up for 1 year, recurrence of epiphora brought on by stent obstruction was 28%. Early stent blockage and the need for periodic irrigation may be indicative of malpositioning of the stent.
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Affiliation(s)
- I P Pabón
- Servicio de Radiología Vascular e Intervencionista, Hospital Universitario de Getafe, Madrid, Spain.
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Abstract
PURPOSE To compare the diagnostic ability and usefulness of carbon dioxide arteriography with that of angiography using iodinated contrast medium in ischemia of the lower extremities. METHODS Between April 1997 and February 1998 arteriography was performed systematically in 50 consecutive patients (42 men, eight women; average age, 65 years), who presented with peripheral vascular disease of the arteries of the lower extremities, with use of both CO2 and iodinated contrast medium. Untoward events that occurred during the examinations and the resulting clinical problems were recorded. Subsequently, two radiologists carried out a double-blind evaluation of the images obtained for each segment (aorta, pelvis, thighs, knees, legs, and feet) using the two different contrast agents to diagnose the arterial condition (normal, aneurysm, stenosis, and occlusion). Afterward, the two types of study performed for each patient were compared to assess the overall quality of CO2 arteriography as opposed to arteriography performed with use of iodinated contrast material. RESULTS Forty-eight percent of the patients reported discomfort during the CO2 examinations and 18% of the studies had to be discontinued as a result. When problems relating to poor image quality were included, only 36% of the arteriograms obtained with use of CO2 were complete. Evaluation was possible in only 25% of CO2 studies of the feet. On average, the overall quality of the arteriograms obtained with use of CO2 was insufficient for diagnosis. CONCLUSION In the authors' experience, CO2 arteriography cannot replace procedures performed with use of iodinated contrast medium for routine examination of ischemia of the lower limbs. In most cases, because of lower tolerance to the procedure and poorer image quality, CO2 imaging was not of sufficient quality to permit diagnosis, particularly at the infrapopliteal level.
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Affiliation(s)
- L P Díaz
- Departamento de Radiología, Hospital Universitario de Getafe, Carretera de Toledo, Madrid, Spain
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Jiménez MQ, Díaz LP, Alvarez M, Moré RL, Zaldegui JR, González MG. [Right ventricle with double outlet associated to total anomalous pulmonary venous drainage to innominate vein]. An Esp Pediatr 1975; 8:24-41. [PMID: 1092241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The clinical findings of 2 patients are studied with an association of malformations not previously reported: double outlet right ventricle and total anomalous pulmonary venous connection to the innominate vein. The following features are worth while to be underlined: 1. Both patients showed a discordance between viscero-atrial situs and direction of the apex; 2. In both cases, particularly in case 2, there existed a very unusual spacial relationship between ventricles, the right ventricle being superior with respect to the left ventricular cavity; 3. From the embryological viewpoint, this ventricular arrangement is supposed to be due to an arrest of the development of the heart in the straight tube stage, there being, however, an upwards expansion of the atrioventricular canal and common atrium; 4. An accurate diagnosis of the common or divided nature of the atrioventricular valves has been impossible in these cases; 5. These combination of lesions constitutes a challenge to cardiologists and surgeons as far as the surgical indication is concerned. In that sense, the simple anastomosis of the common pulmonary vein to the left atrium, although is not a radical cure, may be a feasible and beneficial procedure.
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