DigitalUM :: Browsing by browse.metadata.contributordepartment "Cirugía, Pediatría y Obstetricia y Ginecología"

Browsing by browse.metadata.contributordepartment "Cirugía, Pediatría y Obstetricia y Ginecología"

Now showing 1 - 20 of 214

Open Access
A multifactorial, criteria-based progressive algorithm for hamstring injury treatment
(Lippincott, Williams & Wilkins, American College of Sports Medicine (ACSM), 2017-07) Mendiguchia, Jurdan; Martínez-Ruíz, Enrique; Edouard, Pascal; Morin, Jean-Benoit; Martínez Martínez, Francisco; Idoate, Fernando; Mendez-Villanueva, Alberto; Cirugía, Pediatría y Obstetricia y Ginecología
Introduction: Given the prevalence of hamstring injuries in football, a rehabilitation program that effectively promotes muscle tissue repair and functional recovery is paramount to minimize re-injury risk and optimize player performance and availability. Purpose: To assess the concurrent effectiveness of administering an individualized and multifactorial criteria-based algorithm (RA) on hamstring injury rehabilitation in comparison to employing a general rehabilitation protocol (RP). Methods: Implementing a double-blind randomised controlled trial approach, two equal groups of 24 football players (48 total) completed either an RA group or a validated RP group five days following an acute hamstring injury. Results: Within 6 months after return to sport, 6 hamstring re-injuries occurred in RP versus 1 in RA [relative risk = 6 (90% confidence interval: 1-35); clinical inference: very likely beneficial effect]. The average duration of return to sport was possibly quicker (ES=0.34±0.42) in RP (23.2±11.7 days) than in RA (25.5±7.8 days) (-13.8%, 90%CI: -34.0 to 3.4%; clinical inference: possibly small effect). At the time to return to sport, RA players showed substantially better 10-m time, maximal sprinting speed as well as greater mechanical variables related to speed (i.e., maximum theoretical speed and maximal horizontal power) than the RP. Conclusions: Although return to sport was slower, male football players who underwent an individualized, multifactorial, criteria-based algorithm with a performance- and primary risk factor-oriented training program from the early stages of the process markedly decreased the risk of re-injury compared to a general protocol where long length strength training exercises were prioritized.
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A simple technique for shoulder arthrography
(SAGE Publications, 2006-09) Redondo, M.V.; Martínez Martínez, Francisco; Reus, M.; Alonso, J.; Parrilla, A.; Campos, P.A.; Berná Serna, Juan De Dios; Cirugía, Pediatría y Obstetricia y Ginecología
Purpose: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. Material and Methods: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale.Results: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases.Conclusion: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy.
Open Access
‘Absolute’ inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray
(SAGE Publications, 2021-04-26) Ramírez Sola, Rocío; León Muñoz, Vicente J.; Najem Rizk, Antoine Nicolas; Soler Vasco, Beatriz; Arrieta Martínez, Carlos J.; López Sorroche, Eva; Cárdenas Grande, Encarnación; Salmerón Martínez, Guillermo; Ruiz Molina, José Ángel; Martínez Martínez, Francisco; Santonja Medina, Fernando; Cirugía, Pediatría y Obstetricia y Ginecología
Purpose: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the ‘absolute diagnostic reliability’ of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. Methods: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the ‘absolute reliability’ criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel’s classification systems. Results: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer’s classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer’s classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. Conclusion: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.
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Accessory left atrial cords: a case report and literature review
(Wiley, 2022-05-16) Aranda Domene, Román; Minano Frutos, Celia; Arribas Leal, José M.; Pérez Andreu, Joaquín; Taboada Martín, Rubén; Alfonso Colomer, Laura; Moreno Moreno, José; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
Introduction: Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. Methods: We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. Results: According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. Conclusion: Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.
Open Access
Accuracy of anogenital distance and anti-Müllerian hormone in the diagnosis of endometriosis without surgery
(Wiley, 2019) Sánchez-Ferrer María L.; Jiménez-Velázquez, Raquel; Mendiola, Jaime; Prieto-Sánchez, María T.; Cánovas-López, Laura; Carmona-Barnosi, Ana; Corbalán-Biyang, Shiana; Hernández-Peñalver, Ana I.; Adoamnei, Evdochia; Nieto, Aníbal; Torres-Cantero, Alberto M.; Cirugía, Pediatría y Obstetricia y Ginecología; Ciencias Sociosanitarias
Objective: To assess the predictive ability of a combination of anogenital distance (AGD) and anti-Müllerian hormone (AMH) to diagnosis the presence of endometriosis without surgery. Methods: The present study included women diagnosed with endometriosis and a control group who attended the "Virgen de la Arrixaca" University Hospital, Murcia, Spain, between September 1, 2014, and May 31, 2015. Serum concentrations of AMH were measured, and two AGD measurements were obtained: from the anterior clitoral surface to the upper verge of the anus (AGDAC ), and from the posterior fourchette to the upper verge of the anus (AGDAF ). Data were assessed by receiver operator characteristic (ROC) curves. Results: Women in the endometriosis group (n=57) had significantly shorter AGDAF (22.8 ± 4.6 vs 27.2 ± 5.7 mm; P<0.001) and lower AMH (2.2 ± 2.5 vs 3.3 ± 1.9 ng/mL; P<0.003) compared with the control group (n=93). Women with serum AMH below the clinical cut-off (1 ng/mL) were 17.40-times more likely to have endometriosis (95% confidence interval [CI] 5.64-53.82). The area under the ROC curve of combined AMH and AGDAF was 0.77 (95% CI 0.70-0.85). Conclusion: The model for predicting endometriosis on the basis of AMH and AGD could be useful for clinicians and epidemiologists to improve diagnosis and prognosis of this condition.
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Acute cholecystitis complicating ventriculo-peritoneal shunting: report of a case and review of the literature
(Springer, 2008-03-26) Martínez Lage, Juan F.; Girón Vallejo, Óscar; López López-Guerrero, Antonio; Martínez-Lage Azorín, Laura; Roqués, José Luis; Almagro, María José; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
Case A 3-year-old boy underwent emergency external ventricular drainage and excision of a fourth ventricle anaplastic ependymoma. A week later, the child was given a ventriculo-peritoneal shunt. Fourteen days after shunting, the child developed a subphrenic abscess and acute cholecystitis that required surgery. Results A Staphylococcus epidermidis was isolated both from the ventricular catheter and CSF and from the subphrenic abscess and the gallbladder. To our knowledge, this is the first report of cholecystitis evolving as a descending shunt infection. The current literature related with this unique complication is briefly reviewed.
Open Access
Acute dislocation of the elbow: an all-arthroscopic repair of the lateral ligament complex
(Elsevier, 2023-10-23) Martínez Martínez, Francisco; Martínez García, Celia; García López, Antonio; León Muñoz, Vicente J.; Santonja Medina, Fernando; Cirugía, Pediatría y Obstetricia y Ginecología
The elbow is one of the most commonly dislocated joints. While conservative management is frequently performed for simple elbow dislocations, the importance of primary surgical treatment is still undetermined. However, promising results have been reached after surgical repair. We propose an arthroscopic surgical repair of the lateral ligament complex (LCL), performed with a horizontal suture and 2 Fibertak Knotless implants (Arthrex) placed on the LCL origin, one anterior and the other posterior. Operative treatment should be performed in patients with moderate and gross elbow laxity to avoid post-traumatic sequelae and decrease revision rates. Arthroscopic techniques create fewer complications. This procedure allows one to address intra-articular elbow joint pathology with less chance of wound complications and the ability to use bone anchors if desired.
Open Access
Alianza Global para Renaturalizar la Salud de la Infancia y Adolescencia
(Lúa Ediciones 3.0, 2023-03-03) Juan Antonio Ortega García; Ortega García, Juan Antonio; Juan Antonio Ortega García; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
Capítulo procedente del Congreso de Actualización en Pediatría 2023 que presenta la Alianza Global para Renaturalizar la Salud de la Infancia y Adolescencia —GRSIA—, promovida por la Asociación Española de Pediatría —AEP— y su Comité de Salud Medioambiental. La iniciativa reúne a unidades de salud medioambiental pediátrica, centros de investigación, organizaciones ambientales, entidades educativas, sociedad civil y patronal de las energías renovables para impulsar la prescripción de naturaleza, el autocuidado, la neutralidad de carbono y la integración de soluciones basadas en la naturaleza en hogares, centros sanitarios, centros educativos y ciudades. Entre sus socios se incluyen PEHSU-Murcia / IMIB-Pascual Parrilla, PEHSU-Cat, IEO-CSIC, EH2 Lab, SEO/BirdLife, Instituto Jane Goodall, ANPIER y FAPA Francisco Giner de los Ríos. El texto revisa beneficios del contacto con la naturaleza y plantea tareas de investigación, formación, divulgación, creación de capacidades y liderazgo transformacional en salud medioambiental pediátrica.
Open Access
Altered materno-fetal transfer of 13C-polyunsaturated fatty acids in obese pregnant women.
(2020-04) Gázquez, A.; Prieto-Sánchez, Maria T.; Blanco-Carnero, J.E.; Ruiz-Palacios, M.; Nieto, A.; van Harskamp, D.; Oosterink, J.E.; Schierbeek, H.; van Goudoever, J.B.; Demmelmair, H.; Koletzko, B.; Larqué, E.; Cirugía, Pediatría y Obstetricia y Ginecología
Maternal obesity at conception is considered a major predictor of offspring obesity. This could by driven at least in part by an altered placental fat transfer. However, the pathophysiological mechanisms involved are not fully understood. We investigated the in vivo materno-fetal transfer of fatty acids (FAs) in obese pregnant women using stable isotopes. Ten obese and ten normo-weight pregnant women (control) received orally a bolus of 13C-labeled FAs 12 h before elective caesarean section: oleic acid (13C-OA), linoleic acid (13C-LA) and docosahexaenoic acid (13C-DHA). Maternal blood samples were collected at -12 (basal), -8, -4, -2, 0 h relative to the time of cesarean section. At the time of birth, arterial and venous cord bloods as well as placental tissue were collected. FAs composition was determined by gas-liquid chromatography and isotopic enrichment by gas chromatography-combustion-isotope ratio mass spectrometry. Maternal plasma insulin and placental weight tended to higher values in obese pregnant women although they did not present serum hyperlipidemia. Higher concentrations of 13C-LA and 13C-DHA were found in non-esterified FAs fraction in maternal plasma of obese mothers. The ratio of placental uptake for 13C-LA and 13C-DHA was lower in obese women compared to normal weight pointing toward a limited capacity of FA placental transfer, especially of essential FAs. Maternal insulin was associated to this lower placenta/maternal plasma ratio for both 13C-LA (R = -0.563, P = 0.012) and 13C-DHA (R = -0.478, P = 0.033). In addition, the ratio cord/maternal plasma of 13C-LA was significantly lower in obese women compared to controls. In conclusion, obese mothers without hyperlipidemia showed a reduced materno-fetal transfer of polyunsaturated FAs which could affect fetal development. This affect dietary recommendation for obese pregnant women.
Open Access
Análisis del remodelado anatomoeléctrico auricular para la predicción del éxito de la ablación quirúrgica concomitante de la fibrilación auricular a largo plazo
(Elsevier, 2016-05) Martín, Elio; Hornero, Fernando; Rieta, José Joaquín; Hernández, Antonio; Paredes, Federico; Mena, Armando; Gil, Óscar; Cánovas López, Sergio; García, Rafael; Martínez León, Juan; Cirugía, Pediatría y Obstetricia y Ginecología
Objetivo Identificación de parámetros de remodelado auricular anatomoeléctrico preoperatorios que permitan seleccionar un subgrupo de pacientes favorable al restablecimiento del ritmo sinusal (RS) a largo plazo tras ablación quirúrgica concomitante de fibrilación auricular (FA) persistente-permanente. Métodos Cincuenta pacientes consecutivos sometidos a ablación quirúrgica concomitante de FA persistente-permanente por patrón Maze IV mediante crioblación y radiofrecuencia bipolar. Preoperatorio: se consideraron variables demográficas, morbilidad, tiempo de evolución de FA, estudio de ecocardiografía transtorácica y registro de electrocadiograma digital para análisis de organización de señal de ondas f (entropía muestral [SampEn]). Valoración de la asociación individual y conjunta de los parámetros de remodelado auricular con la restauración de RS mediante área bajo la curva ROC (ABC). Resultados Seguimiento medio 22,32 ± 3,19 meses. Tiempo medio de evolución de FA 4,00 ± 4,28 años. Diámetro auricular izquierdo medio 49,90 ± 8,18 mm (rango = 32–81 mm). Restauración RS 62% al cierre del seguimiento. Los parámetros que mejor se asociaron con la restauración de RS postoperatorio fueron el diámetro auricular izquierdo (ABC = 0,848) y SampEn (ABC = 0,845). Hallados puntos de corte para ambos en 50 mm y 0,0857, respectivamente; se obtuvo un modelo con capacidad predictiva ABC = 0,893. Conclusiones El análisis del grado de remodelado auricular anatomoeléctrico preoperatorio mediante variables indirectas incruentas podría ser útil para seleccionar los pacientes más favorables para el restablecimiento de RS tras ablación concomitante de FA. ---------------------------
Embargo
Analysis of the postoperative epicardial auriculogram after surgical ablation of atrial fibrillation: Risk stratification of late recurrences
(Elsevier, 2007-06) Hornero, Fernando; Rodríguez, Ignacio; Estevez, Vanesa; Gil, Óscar; Cánovas López, Sergio; García, Rafael; Martínez León, Juan; Cirugía, Pediatría y Obstetricia y Ginecología
Objectives Late recurrence of atrial fibrillation frequently occurs after atrial ablation. Risk stratification for success and recurrence of the antiarrhythmic surgical procedure has not yet been established. We studied postoperative epicardial unipolar auriculograms to distinguish between high- and low-risk patients with late recurrence of atrial fibrillation. Methods Epicardial atrial fibrillatory activity was registered in 70 patients with surgical ablation of permanent atrial fibrillation and postoperative recurrence through the temporary wires. The atrial activation pattern was characterized in 3 groups (type I, II, and III) using Wells’s criteria. The groups were homogeneous in the main clinical preoperative and surgical variables. Results Mean atrial frequency of postoperative atrial fibrillation recurrence showed differences between groups: 225 ± 53 ms in type I, 177 ± 21 ms in type II, and 150 ± 19 ms in type III (P < .01). At the end of the study, sinus rhythm was achieved in 80% of the subjects with type I, 87.5% with type II, and 23.8% with type III (P < .001). During follow-up, late atrial fibrillation recurred in 21.7% of patients with type I, 17.4% with type II, and 64.2% with auriculogram type III. In multivariate regression analysis, the postoperative auriculogram type III was the only predictor of late atrial fibrillation recurrence (odds ratio 15.6; 95% confidence interval, 3.2–74.7; P < .001). Conclusions The unipolar epicardial auriculogram was able to characterize the complexity of the postoperative fibrillatory process and also to identify patients with a high risk of late recurrence. Auriculogram type III had a low success rate for the intraoperative ablation procedure. The lines of the ablation procedure facilitated organization of the auriculograms.
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Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement
(Lippincott, Williams & Wilkins, 2013-06-07) Barbanti, Marco; Yang, Tae-Hyun; Rodès Cabau, Josep; Tamburino, Corrado; Wood, David A.; Jilaihawi, Hasan; Blanke, Philips; Makkar, Raj R.; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Binder, Ronald K.; Nguyen, Giang; Freeman, Melanie; Ribeiro, Henrique B.; Kapadia, Samir; Min, James; Feuchtner, Gudrun; Gurtvich, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; Sandoli de Brito, Fabio; Kodali, Susheel; Norgaard, Bjarne L.; Hansson, Nicolaj C.; Pache, Gregor; Canovas López, Sergio; Zhang, Hongbin; Leon, Martin B.; Webb, John G.; Leipsic, Jonathon; Cirugía, Pediatría y Obstetricia y Ginecología
Background—Aortic root rupture is a major concern with balloon-expandable transcatheter aortic valve replacement (TAVR). We sought to identify predictors of aortic root rupture during balloon-expandable TAVR by using multidetector computed tomography. Methods and Results—Thirty-one consecutive patients who experienced left ventricular outflow tract (LVOT)/annular/aortic contained/noncontained rupture during TAVR were collected from 16 centers. A caliper-matched sample of 31 consecutive patients without annular rupture, who underwent pre-TAVR multidetector computed tomography served as a control group. Multidetector computed tomography assessment included short- and long-axis diameters and cross-sectional area of the sinotubular junction, annulus, and LVOT, and the presence, location, and extent of calcification of the LVOT, as well. There were no significant differences between the 2 groups in any preoperative clinical and echocardiographic variables. Aortic root rupture was identified in 20 patients and periaortic hematoma in 11. Patients with root rupture had a higher degree of subannular/LVOT calcification quantified by the Agatston score (181.2±211.0 versus 22.5±37.6, P<0.001), and a higher frequency of ≥20% annular area oversizing (79.4% versus 29.0%, P<0.001) and balloon postdilatation (22.6% versus 0.0%, P=0.005). In conditional logistic regression analysis for the matched data, moderate/severe LVOT/subannular calcifications (odds ratio, 10.92; 95% confidence interval, 3.23–36.91; P<0.001) and prosthesis oversizing ≥20% (odds ratio, 8.38; 95% confidence interval, 2.67–26.33; P<0.001) were associated with aortic root contained/noncontained rupture. Conclusions—This study demonstrates that LVOT calcification and aggressive annular area oversizing are associated with an increased risk of aortic root rupture during TAVR with balloon-expandable prostheses. Larger studies are warranted to confirm these findings.
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Are there differences in basal thrombophilias and C-reactive protein between women with or without PCOS?
(2009-02) Sánchez-Ferrer, María L.; Prieto-Sánchez, María T.; Corbalán-Biyang, , Shiana; Mendiola, Jaime; Adoamnei, Evdochia; Hernández-Peñalver, Ana L.; Carmona-Barnosi, Ana; Salido-Fiérrez, Eduardo J.; Torres-Cantero, Alberto M.; Cirugía, Pediatría y Obstetricia y Ginecología
Polycystic ovary syndrome (PCOS) women have increased cardiovascular risks, although it is unclear whether the haemostatic system and coagulation contribute to that increased risk. Women attending the Gynecology Unit of the 'Virgen de la Arrixaca' University Hospital (Murcia, Spain) for routine gynaecological examinations between September 2014 and May 2016 were assessed for PCOS using the Rotterdam criteria (hyperandrogenism [H], oligo/amenorrhoea [O] and polycystic ovarian morphology [POM]) and were classified into four phenotypic. In total, 126 cases were identified and 159 control women were selected. All women underwent physical and gynaecological examinations, and blood tests between the second and fifth day of the menstrual cycle. Differences in hormonal, basal thrombophilia and metabolic parameters, and C-reactive protein (CRP) between PCOS and controls were analysed. After adjusting by BMI and age, PCOS women had higher LH (P < 0.001), testosterone (P < 0.001), free testosterone (P = 0.01) and anti-Müllerian hormone (P < 0.001) and lower FSH (P = 0.03) compared with controls, whereas sex hormone-binding globulin was no different. Cases showed significantly higher protein S, glucose, insulin and insulin resistance (HOMA-IR) compared with controls (P < 0.05). There were no differences in protein C levels, antithrombin III, prothrombin time, homocysteine, D-dimer, factor V Leyden, prothrombin G20210A polymorphism or CRP. The H+O phenotype showed the poorest results for insulin and HOMA-IR (P = 0.04 and 0.05). The results suggest that there are no differences in the basal thrombophilias between women with and without PCOS. However, PCOS with H+O shows the poorest metabolic profile.
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Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis
(2021-03) lopez-lopez, victor; ruiz-Manzaneda, Juan Jose; Eshmuminov, D; Lehmann, K; Schneider, M; von der Groeben, M; RUIZ DE ANGULO, DAVID; Gajownik, U; PONS, JOSE ANTONIO; SANCHEZ BUENO, FRANCISCO; ROBLES, RICARDO; RAMIREZ-ROMERO, PABLO; Cirugía, Pediatría y Obstetricia y Ginecología
Background: Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation. Methods: Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. Results: A total of 96 patients from 8 articles were included. Bariatric surgery-related morbidity and mortality rates were 37% (95% CI 0.27-0.47) and 0.6% (95% CI 0.02-0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96-36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90-60.26) and 49.2 (95% CI 31.89-66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45-0.75) and 45% (95% CI 0.25-0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. Conclusions: Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies.
Open Access
Artificial chordae in the setting of complex mitral valve repair: early outcomes using the folding leaflet technique
(Oxford University Press, 2014-02-12) García Fuster, Rafael; Martín, Elio; Paredes, Federico; Mena, Armando; Cánovas López, Sergio; Gil, Oscar; Hornero, Fernando; Martínez, Juan; Cirugía, Pediatría y Obstetricia y Ginecología
OBJECTIVES Neochordal repair is particularly limited in case of large prolapse with absence of a reference point on a nearby segment. Our aim was to overcome these limitations by means of a simple technique: the ‘Folding Leaflet’. METHODS Ninety-six patients underwent this technique between January 2009 and August 2012 from a global mitral valve (MV) repair group of 384 patients. A subgroup of 68 patients with complex lesions, bileaflet, commissural or multisegment prolapse, was selected. These more challenging patients were considered as the study group in order to assess the efficacy of our technique. The neochordae were fixed to the papillary muscle with a simple stitch and then were passed through the free margin of the prolapsing leaflet. Free-edge remodelling was achieved weaving this suture and surpassing the coaptation line. Then, the leaflet was folded and its free margin was temporarily approximated edge-to-edge to the adjacent annulus. This was used as the reference point while the neochordae were tied without the need for adjacent healthy chordae or use of callipers. Complete echocardiographic follow-up was obtained at 6-month intervals. RESULTS All patients had ≥2 prolapsed segments: posterior leaflet (40 patients), anterior leaflet (13 patients) or both leaflets (15 patients). Annuloplasty was routinely used and the mean number of neochordae per patient was 4.1 ± 2.2 (2–13). Mean follow-up was 28 ± 14 months (5–49 months). There was only one in-hospital death. Another patient died by pneumoniae (15th postoperative month). At the first-month follow-up, 51 patients had no mitral regurgitation (MR) and 16 patients had Grade 1 MR. Only 1 patient had more than mild regurgitation at the 6-month follow-up. There was no evidence of Grade 3 or 4 MR in any patient. At the 2-year follow-up, 34 patients remained with no MR or trace MR and 7 patients had Grade 1 MR. CONCLUSIONS MV repair for complex degenerative MR using this technique of neochordal repair results in excellent early and mid-term outcomes. This technique facilitates the extensive use of neochordae in case of large areas of prolapse.
Open Access
Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome
(Elsevier, 2018) Hernández-Peñalver, Ana I.; Sánchez-Ferrer, María L.; Mendiola, Jaime; AdoamneI, Evdochia; Prieto-Sánchez, María T.; Corbalán-Biyang, Shiana; Carmona-Barnosi, Ana; Nieto, Aníbal; Torres-Cantero, Alberto M.; Cirugía, Pediatría y Obstetricia y Ginecología
Is anogenital distance (AGD) a useful clinical tool for predicting polycystic ovarian syndrome (PCOS) and its main National Institutes of Health (NIH) phenotypes? Case-control study conducted between September 2014 and May 2016 at the Department of Obstetrics and Gynecology of the University Clinical Hospital 'Virgen de la Arrixaca' in the Murcia region (south-eastern Spain). One hundred and twenty-six cases of PCOS and 159 controls without PCOS were included. AGD measurements were taken from the anterior clitoral surface to the upper verge of the anus (AGDAC), and from the posterior fourchette to the upper verge of the anus (AGDAF). Parametric and non-parametric tests and receiver operating characteristic (ROC) curves were used to assess associations between AGD and the presence of PCOS and its phenotypes. AGDAC, but not AGDAF, was associated with PCOS and all its phenotypes (P-values < 0.001 to 0.048). The highest area under the curve (0.62; 95% confidence interval 0.55 to 0.71) was obtained for all PCOS with AGDAC with a sensitivity and specificity of 50.0% and 73.0%, and positive and negative predictive value of 59.0% and 64.4%, respectively. AGDAC could moderately discriminate the presence of PCOS and may be a useful clinical tool.
Open Access
Assessment of the range of movement of the lower limb in sport: advantages of the ROM-SPORT I battery
(MDPI, 2020-10-19) De Ste Croix, Mark; Ayala Rodríguez, Francisco; Cejudo Palomo, Antonio; Sainz de Baranda Andújar, Pilar; Santonja Medina, Fernando; Cirugía, Pediatría y Obstetricia y Ginecología
Range of movement (ROM) assessment is an important strategy to increase physical-technical performance and minimize the risk of sports-related injuries. Currently, there is no consensus regarding which ROM assessment method is the most appropriate. The main objective of this study was to perform a systematic review of the test batteries available for the assessment of lower limb ROM; additionally, we compare the ROM-SPORT I battery with those previously reported in the literature. The systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The identification of publications was made by using the databases SciELO, Medline, Scopus, PubMed, and Web of Science. Based on the inclusion criteria, sixteen publications were selected and analyzed. The ROM-SPORT I battery is the most valid of the analyzed methods. This battery evaluates the ROM of eleven lower limb movements. The inclinometer with a telescopic arm and a box is a simpler, more comfortable, and faster procedure than others. The Lumbosant support and use of two examiners are essential to avoid compensatory movements to obtain reliable measurements during ROM assessment. The ROM-SPORT I is a field-based battery of tests that may be used by sports professionals, clinics, and researchers in applied settings to accurately assess and monitor lower extremity ROM.
Open Access
Assessment of the tissue response to modification of the surface of dental implants with carboxyethylphosphonic acid and basic fibroblastic growth factor immobilization (Fgf-2): an experimental study on minipigs
(MDPI, 2021-04-23) Aragoneses, Javier; Suárez, Ana; López Valverde, Nansi; Martínez Martínez, Francisco; Aragoneses, Juan Manuel; Cirugía, Pediatría y Obstetricia y Ginecología
Simple Summary This study aimed to evaluate the efficacy of treating the surface of dental implants with carboxyethylphosphonic acid for the immobilization of FGF-2, the influence of FGF-2 on cortical bone in close contact with dental implants, new bone formation around dental implants in the presence of FGF-2 and the influence of FGF-2 on the interthread bone area of dental implants during the healing period after insertion. Abstract The aim of this study was to evaluate the effect of implant surface treatment with carboxyethylphosphonic acid and fibroblast growth factor 2 on the bone–implant interface during the osseointegration period in vivo using an animal model. The present research was carried out in six minipigs, in whose left tibia implants were inserted as follows: eight implants with a standard surface treatment, for the control group, and eight implants with a surface treatment of carboxyethylphosphonic acid and immobilization of FGF-2, for the test group. At 4 weeks after the insertion of the implants, the animals were sacrificed for the histomorphometric analysis of the samples. The means of the results for the implant–bone contact variable (BIC) were 46.39 ± 17.49% for the test group and 34.00 ± 9.92% for the control group; the difference was not statistically significant. For the corrected implant–bone contact variable (BICc), the mean value of the test group was 60.48 ± 18.11%, and that for the control group, 43.08 ± 10.77%; the difference was statistically significant (p-value = 0.035). The new bone formation (BV/TV) showed average results of 27.28 ± 3.88% for the test group and 26.63 ± 7.90% for the control group, meaning that the differences were not statistically significant (p-value = 0.839). Regarding the bone density at the interthread level (BAI/TA), the mean value of the test group was 32.27 ± 6.70%, and that of the control group was 32.91 ± 7.76%, with a p-value of 0.863, while for the peri-implant density (BAP/TA), the mean value of the test group was 44.96 ± 7.55%, and that for the control group was 44.80 ± 8.68%, without a significant difference between the groups. The current research only found a significant difference for the bone–implant contact at the cortical level; therefore, it could be considered that FGF-2 acts on the mineralization of bone tissue. The application of carboxyethylphosphonic acid on the surface of implants can be considered a promising alternative as a biomimetic coating for the immobilization of FGF-2. Despite no differences in the new bone formation around the implants or in the interthread or peri-implant bone density being detected, the biofunctionalization of the implant surface with FGF-2 accelerates the mineralization of the bone–implant interface at the cortical level, thereby reducing the osseointegration period.
Open Access
Atrapamiento por succión en una piscina
(Elsevier, Asociación Española de Pediatría, 2011-03-03) Girón Vallejo, Óscar; Cabrejos, K.; Villacieros, L.; Vives, I.; Ruiz Jiménez, J.I.; Cirugía, Pediatría y Obstetricia y Ginecología; Facultad de Medicina
Open Access
Beyond Precision: Ambiomic Survivorship in Childhood and AYA Cancer
(MDPI, 2026) Ortega García, Juan Antonio; Shakeel, Omar; Wood, Nicole M.; Pérez-Martínez, Antonio; Fuster Soler, José Luis; Miller, Mark D.; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
Revisión narrativa que propone un modelo ambiómico de supervivencia en cáncer infantil y del adolescente y adulto joven, desplazando el seguimiento desde la vigilancia postratamiento hacia una atención anticipatoria iniciada en el diagnóstico. El artículo integra marcos internacionales de supervivencia —COG, IGHG, PanCare y NCCN— con evidencia sobre determinantes ambientales, exposoma, toxicogenómica, salud pública e implementación clínica. A partir de la experiencia de la Historia Clínica Ambiental Pediátrica y del programa PLASESCAP-MUR de Murcia, describe la evolución hacia el Ambiomic Health Compass, incorporando evaluación ambiental y social estructurada, Green Page, Green Passport, biomonitorización, datos geoespaciales y alertas dinámicas. El modelo PEHis–AHC se plantea como una referencia escalable para integrar salud ambiental en oncología pediátrica, reducir eventos prevenibles y mortalidad relacionada con el tratamiento, mejorar la equidad y reforzar la continuidad asistencial desde el diagnóstico y a lo largo de la supervivencia.