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Background The Burn Specific Health Scale-Brief (BSHS-B) is considered a validated questionnaire to evaluate quality of life after burn. The purpose of this study was to translate the BSHS-B into Spanish and perform its cross-cultural adaptation. Methods First, BSHS-B was translated from English into Spanish. Subsequently, 84 patients answered the Spanish version of BSHS-B and SF-36 scales to assess the reliability (Cronbach’s alpha), construct validity (Spearman rank test), and stability in time (intra-class correlation coefficient). Results The BSHS-B-Sp showed a good internal consistency with a global Cronbach’s alpha of 0.96. Correlations between the major domains of BSHS-B and SF-36 are reported with Spearman’s coefficient ranging from 0.29 to 0.87 in all sub-domains (p p Conclusions The Spanish version of the BSHS-B demonstrated an appropriated internal consistency, construct validity, and stability in time. This fact supports its applicability to evaluate the quality of life of burn patients. Level of evidence: Not gradable

Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy. PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation. Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99–1.05; I2 = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12–1.23; I2 = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84–0.94; I2 = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with

Background Intragastric balloon placement is an ideal weight loss method for those unfit or unwilling to undergo surgery. It is not known if multidisciplinary team management helps these patients the way it does with those who enroll in bariatric surgery programs. Objectives The primary objective was to assess the efficacy of intragastric balloon on weight loss after a 6-month follow-up and the secondary objective was to assess the impact of multidisciplinary team intervention (psychological consultation, nutritional follow-up, and regular physical activity) on weight loss in the study patients. Setting Referral military tertiary care center, Mexico. Methods Retrospective study of 159 patients treated with intragastric balloon between June 2011 and December 2016 in a single institution with aims of assessing its efficacy and the impact of regular exercise, supervised diet, and psychological consultation during the intervention. Results One hundred fifty-nine patients were enrolled. There were no drop-offs nor patients lost to follow-up. The mean initial weight was 92.6 ± 12.6 kg with a decrease to a mean of 80.7 ± 12.4 kg at 6 months with a mean reduction of 11.9 kg (P Conclusions Intragastric balloon managed patients get additional benefit on weight loss with psychological follow-up and exercise during the intervention. Given the retrospective nature of the study, further studies are needed to definitive conclusions.

Sixty-two centres in 16 countries contributed with 2,694 open fractures cases to an international, multi-centric, retrospective cohort study involving different healthcare settings. The INTELLECT study results show that there are significant disparities on the management of open lower limb fractures internationally. A timely, multidisciplinary, guideline-directed care is a protective factor for developing infective complications, non-union and requiring an amputation.

Background Burns are one of the most common causes of mortality and morbidity among children. This study aims to assess the epidemiology of pediatric major burns in a third level hospital in Spain to evaluate demographics, etiology, and outcomes. Methods A retrospective study was held by the Plastic, Reconstructive and Burn Surgery department of the hospital. We included 147 patients under 18 admitted to hospital between January 2008 and December 2020 who meet the inclusion criteria: partial thickness burns > 10% total body surface area (TBSA) in patients Results Three groups of age were analyzed. The average %TBSA was 18.7 (SE 0.9). Scalds were the main mechanism of injury (70.1%) and upper extremity was the most frequent location affected (68%). The 28.6% of patients suffered some complication, but the mortality rate was low (0.7%). In our series, the group aged 13–18 showed significantly higher %TBSA, more number of surgeries and blood transfusions. Conclusions Scald burns are the most frequent mechanism of injury in pediatric burns. However, teenagers suffer more severe burns and complications, usually caused by flame. Despite the low mortality rates, more measures of prevention should be taken to increase children security. Level of evidence: Level IV, Risk/Prognostic.

Obesity has an especial implication for women of childbearing age because of a higher risk of adverse outcomes during pregnancy and labor. This report aimed to analyze complications of pregnancy after sleeve gastrectomy (SG) concerning the time after surgery.A retrospective descriptive-analytical study was conducted including women of childbearing age who underwent sleeve gastrectomy (SG) from 2006 to 2017. Patients were divided into two groups regarding the time elapsed from SG to pregnancy: less than and greater than one year (group A /group B, respectively).During the studied time, 51 pregnancies with complete clinical records were found. The mean weight and gestational age (GA) of the newborn (NB) were normal. The mean time from surgery to pregnancy was 30.4 ± 21 months. Patients from Group A and B presented 28.6% and 16.7% respectively of preterm NB (p = 0.5). Group A registered no low birth weight (LBW) babies (3.0 ± 0.4 kg) with a GA of 37.2 ± 2.1 weeks, while in Group B, 8.6% of NB were at LBW 2.1 ± 0.1 kg and GA of 33.3 ± 3.8 weeks (p = NS).After SG, no differences in terms of maternal and neonatal complications were found concerning the time between surgery and pregnancy.

Social distancing to curb the COVID-19 pandemic has impacted medical and surgical education. This health crisis led us to raise doubts, controversies, and dilemmas in health care in general, and in surgery in particular, understanding that residents are possibly as or more vulnerable than all health professionals. During the 32nd International Congress of General Surgery in Cordoba, which was the first general surgery congress held in Argentina during 2021; The Association of Residents and Concurrent Surgery of Cordoba presented its official report about the current challenges faced by residents during their surgical training.

We report the prenatal ultrasonographic diagnosis of a case of meconium peritonitis in a 33-week fetus, who was born preterm and the diagnosis was confirmed with ultrasound, radiography and postnatal surgery. The neonate underwent exploratory laparotomy, in which a meconium pseudocyst was debrided, the perforated intestinal area was resected and end-to-end anastomosis was performed. The initial evolution was torpid, but he was finally discharged with good intestinal function.

Introducción: el síndrome de cola de caballo (SCC) es una entidad poco frecuente, provocado por la compresión de las raíces nerviosas en el canal a nivel de la cola de caballo. Puede dejar graves secuelas si no es diagnosticado y tratado de forma precoz. Únicamente 2% a 6% de las hernias discales lumbares van a provocar un SCC. El diagnóstico de esta patología se basa en criterios clínicos, siendo éstos objeto de controversia dada la variabilidad de presentación del cuadro clínico. El objetivo de este trabajo es analizar la presentación clínica y evolución posoperatoria de los pacientes intervenidos por SCC secundaria a hernia de disco por equipo del Centro de Deformidades de Columna (CE.DEF.CO), entre enero de 2009 y diciembre de 2018. Material y método: realizamos un análisis retrospectivo. La población objetivo son los pacientes intervenidos por SCC secundario a hernia discal entre enero de 2009 y diciembre de 2018 por equipo del CE.DEF.CO. Analizamos 20 pacientes intervenidos quirúrgicamente, de ellos 17 (85%) casos presentaron síntomas urinarios, 18 (90%) casos dolor o elementos deficitarios en miembros inferiores, 13 casos anestesia/hipoestesia en silla de montar, 6 casos síntomas intestinales y 3 casos presentaron disfunciones sexuales. En 19 casos se realizó procedimiento quirúrgico antes de las 48 de iniciados los síntomas. Resultados: la remisión de síntomas esfinterianos al mes es de 83% y al año posoperatorio de casi 87%. Se constató un caso de disfunción sexual al año posoperatorio. Conclusión: el diagnóstico precoz por el médico emergencista es fundamental, por lo que el conocimiento de esta patología es imprescindible. Nuestros resultados en pacientes intervenidos de forma precoz, antes de las 48 horas, fueron similares a los publicados en la bibliografía internacional con bajo porcentaje de secuelas.

Background Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979–2018. Methods Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. Results Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. Conclusions Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.

[Background]: Telemedicine technologies have a valuable potential when it comes to improving the accuracy of triage protocols in selecting severely injured patients who may benefit from transportation. The main objective of this study was to evaluate the correlation of the urgent diagnosis made by telemedicine through an App with traditional face-to-face urgent care and the final diagnosis, made by scheduled consultation., [Methods]: We carried out a descriptive cross-sectional study to evaluate the accuracy of telemedicine in burns evaluation compared to gold standard (in-person consultation). An App was designed. All patients enrolled were evaluated by both teleconsultation and face-to-face approach on burn emergencies. Diagnosis on presentation made by a physician constituted the gold standard., [Results]: A total of 202 patients were included in the study. The use of TM was able to detect that 83.17% of the patients attending the BU could have been managed on as outpatient basis. The intra-observer concordance was k = 0.94 (95% CI: 0.90–0.97). These results highlight a very high sensitivity and specificity (99.40 and 100% respectively)., [Conclusions]: The telemedicine system for planning referrals is a useful tool that may make significant differences in the management of burned patients although further research needs to be taken in that direction.

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the &ldquo, time-within-remission range&rdquo, as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 &plusmn, 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, &ldquo, and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 &plusmn, 9.2 years old, body mass index (BMI) 46.3 &plusmn, 6.9 kg/m2) underwent primary bariatric procedures. &ldquo, Time-within-remission range&rdquo, were 83.3% (33.3&ndash, 91.6) after gastric bypass, 68.7% (7.1&ndash, 87.5) after sleeve gastrectomy and 90% (83.3&ndash, 92.8) after malabsorptive techniques (p &lt, 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the &ldquo, The association of bariatric techniques with &ldquo, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34&ndash, 5.84), p &lt, 0.001 for malabsorptive techniques and OR 0.55 (0.40&ndash, 0.75), p &lt, 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The &ldquo, unveils a superiority of gastric bypass compared to sleeve gastrectomy.

Background: The most commonly used technique in the management of hydrocephalus is a neurosurgical procedure, known as ventriculoperitoneal shunt (VPS). Several complications of the distal end of a VPS catheter have been described in the literature, although migration and erosive bladder perforation of this shunt are extremely uncommon. Case Description: We relate a rare pediatric case of a 4-year-old boy, with long-term dysuria, intermittent incontinence, and chronic abdominal pain developed during a myelomeningocele postoperative period, without other symptoms. A bladder fistula with the distal end of the VPS inside the bladder was observed while performing an ultrasound to investigate the urinary tract. Two months before the current surgical approach, the patient, with hydrocephalus and alterations compatible with Chiari malformation, was treated with VPS and subsequently subjected to the third ventriculostomy. The child was unsuccessfully treated with an infraumbilical laparotomy, with section and careful traction of the catheter. A vesicostomy was then performed and the catheter was observed to form an intravesical knot. Conclusion: The intravesical knot formation is extremely rare and its mechanism of formation is still not well understood. Patients with VPS need adequate medical follow-up to identify possible complications of the shunt.

Objectives: Congenital aplasia cutis is an uncommon disease characterized by the absence of the dermal tissue and epidermis. Fatal cases due to sagittal sinus hemorrhage are very rare. Case report: We report the case of 1-month-old boy, presenting with a purple and softened lesion in the scalp, from anterior to posterior fontanel area, with 2.5x6.5 cm in size, characterizing congenital aplasia cutis. He had presented with multiple episodes of scalp hemorrhage. The patient, referred to the Department of Neurosurgery, presented with active bleeding. The patient was submitted to an emergency operation aiming to stop bleeding: a direct communication between the lesion and the superior sagittal sinus was noticed. The infant died two days after. Conclusion: We conclude that early treatment is imperative, although most of the time the treatment is effective, wherever conservative or surgical. Unfortunately as shown here congenital aplasia cutis may still have an unfavorable evolution. It is also important to spread up appropriate information to any possible interdisciplinary teams involved with, aiming to promote eraly treatment and to avoid life-threatening bleeding and other potentially fatal complications.

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

Background: Facial nerve dysfunction may occur immediately after vestibular schwanoma surgery. Electromyographyc monitoring of motor cranial nerves during cerebellopontine angle surgery has become an essential tool. Although delayed onset of facial nerve dysfunction hours to months following vestibular schwanoma surgery are rare. Case description: We describe the case of a 70-years-old male who was admitted with a left side tinnitus and hearing loss of the last 3 years. Magnetic resonance imaging (MRI) T1-weighted demonstrated an isointensity lesion, 30mm in diameter, at the left cerebello-pontine angle with a small portion in the internal auditory canal. The patient was surgically treated by means of a standart suboccipital retrosigmoid approach. The facial nerve was monitored by continuously during surgery. Surgical removal was macroscopically complete. The facial nerve was well-preserved during surgery and showed at the end of the procedure normal electromyographic activity. The patient did well postoperatively and was discharged at the 4th postoperative day and facial function was normal (House-Brackmann grade I). On the 10th postoperative day he notices difficult closing his left eye that progressed to complete facial nerve palsy (House-Brackmann grade III). Steroid therapy was performed for five days associated with physical therapy. One month later his facial nerve function had completely recovered. After six months, the patient remains asymptomatic and neurologically intact. MRI obtained at the 16th postoperative day showed intense enhancement of the intracranial facial nerve segment and also demonstrated no residual tumor. Immunological study at the time of onset showed herpes simplex virus antibody titer normal as well as those for herpes zoster virus. Conclusions: Delayed facial nerve palsy remains an under reported and consequently not very known phenomenon in the neurosurgical practice and literature. Because of the 2009favorable rate of recovery, patients should be reassured in the interim and should not undergo any corrective surgical procedures to improve facial nerve function. Delayed facial nerve palsy is uncommon after vestibular schwannoma surgery. Excellent recovery of facial nerve function to the original postoperative status nearly always occurs in those circumstances.

Summary Background While liver surgery has become a safe and feasible operation technique, the incidence of postoperative liver dysfunction still remains a central problem. Approximately 10% of patients undergoing liver resection were shown to develop liver dysfunction, which is associated with an increased risk of morbidity and mortality. Yet, to date there is no effective treatment option for postoperative liver dysfunction available. The development of postoperative liver dysfunction was linked to a disruption in the liver’s potential to regenerate. Thus, it is importance to elucidate the underlying mechanisms of liver regeneration and to find potential therapeutic targets for the treatment of patients with postoperative liver dysfunction. Methods A review of the literature was carried out. Results We report on potential future interventions for improvement of liver regeneration after surgical resection. Moreover, we evaluate the benefits and drawbacks of hepatic progenitor cell therapy and hematopoietic stem cell therapy. However, the most significant improvement seems to come from molecular targets. Indeed, von Willebrand factor and its pharmacologic manipulation are among the most promising therapeutic targets to date. Furthermore, using the example of platelet-based therapy, we stress the potentially adverse effects of treatments for postoperative liver dysfunction. Conclusion The present review reports on the newest advances in the field of regenerative science, but also underlines the need for more research in the field of postoperative liver regeneration, especially in regard to translational studies.

Social distancing to curb the COVID-19 pandemic has impacted medical and surgical education. This health crisis led us to raise doubts, controversies, and dilemmas in health care in general, and in surgery in particular, understanding that residents are possibly as or more vulnerable than all health professionals. During the 32nd International Congress of General Surgery in Cordoba, which was the first general surgery congress held in Argentina during 2021; The Association of Residents and Concurrent Surgery of Cordoba presented its official report about the current challenges faced by residents during their surgical training.

Background & Aims Besides its critical role during liver regeneration, serotonin (5-HT) has been found to act as a mitogenic factor in several neoplastic entities. Accordingly, we aimed to evaluate whether intra-platelet 5-HT (IP5-HT) was associated with oncological outcome after liver resection and concomitantly evaluate its ability to serve as a therapeutic target to promote liver regeneration. Methods A total of 96 patients undergoing liver resection for malignant liver tumors were prospectively included. Optimized plasma and serum preparation were performed and IP5-HT levels were determined. Patients were followed up for postoperative liver dysfunction (LD), morbidity, disease free and overall survival (OS). Results We found increased preoperative IP5-HT levels in patients with disease recurrence at 6 and 12months ( p =0.046, p =0.020, respectively). In clear contrast, patients suffering from postoperative morbidity, severe morbidity or LD had significantly reduced IP5-HT levels ( p =0.011, p =0.035, p =0.003, respectively). Patients with high IP5-HT levels (>134ng/ml) suffered from an increased incidence of postoperative disease recurrence at 6 and 12months ( p =0.045, p =0.006, respectively) but exhibited a reduction in morbidity, severe morbidity, and LD ( p =0.006, p =0.008, p =0.005, respectively). We confirmed these results in our two largest subgroups, demonstrating that they were independent of tumor type. This bivalent effect of IP5-HT was also reflected in patients receiving selective serotonin reuptake inhibitor treatment, who displayed a reduction in disease recurrence accompanied by an increase in postoperative morbidity. Yet, both early disease recurrence and morbidity worsened OS. Conclusion Herein, we present first clinical evidence for IP5-HT being associated with early disease recurrence after liver resection in humans. Thus, pharmacological intervention at the level of platelets and platelet-derived 5-HT to promote liver regeneration should be considered with caution. A careful definition of indications and timing is needed to promote liver regeneration without inducing deleterious effects. Lay summary Preoperative intra-platelet serotonin (IP5-HT) levels seem to substantially affect patient outcomes after liver resection for liver tumors. While there is a narrow window of IP5-HT levels where liver regeneration and tumor progression is balanced, excessively high IP5-HT levels (>134ng/ml IP5-HT) lead to an increased incidence of early tumor recurrence and excessively low IP5-HT levels ( ClinicalTrials.gov-Identifier: NCT01700231.

Infections after surgical interventions are assumed to be caused by contamination. We show by analyzing multicentric data of 6561 patients that surgical infections as well as sepsis had a predominantly enteric microbial signature irrespective of the type of surgery, suggesting failure of intestinal bacterial compartmentalization. In mice, we reveal that hepatic surgery induced dysregulation of intestinal and hepatic type 3 innate lymphoid cells (ILC3s) and intestinal leakage resulting in enteric bacterial translocation via lymphatic vessels. In the absence of hepatic ILC3s, inflammasome activation and the induction of antimicrobial peptide encoding genes, bacteria colonized remote systemic organs and impaired surgical outcomes. Conversely, mammalian-microbial commensalism is required for the education of host immunity to ensure optimal hepatic healing responses. In fact, microbial-derived products were sufficient for the induction of proliferative transcriptional networks in the mouse liver, as illustrated by serum transfer experiments, mass spectrometry and RNA expression analysis, indicating that the balanced exposure of the host to commensals is essential for recovery. This study reveals the intestinal origin of microbes causing complications after surgical interventions and highlights host protective mechanisms of controlled commensalism that prevent infections.One Sentence SummaryIntestinal bacteria cause surgical infections

BACKGROUND: To date, definitions of liver dysfunction (LD) after hepatic resection rely on late postoperative time points. Further, the used parameters are markedly influenced by perioperative management. Thus, we aimed to establish a very early postoperative score to predict postoperative mortality. METHODS: Liver related parameters were evaluated after liver resection in a retrospective evaluation cohort of 228 colorectal cancer patients with liver metastasis (mCRC) and subsequent validation in a prospective set of 482 consecutive patients from 4 independent institutions undergoing hepatic resection was performed. RESULTS: C-reactive protein (CRP, AUC =0.739, P

Background Neoadjuvant chemotherapy (NeoCTx) is performed for most patients with colorectal cancer liver metastases (CRCLM). However, chemotherapy-associated liver injury (CALI) has been associated with poor postoperative outcome. To date, however, no clinically applicable and noninvasive tool exists to assess CALI before liver resection. Methods Routine blood parameters were assessed in 339 patients before and after completion of NeoCTx and before surgery. The study assessed the prognostic potential of the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), the albumin-bilirubin grade (ALBI), and their combinations. Furthermore, an independent multi-center validation cohort (n = 161) was included to confirm the findings concerning the prediction of postoperative outcome. Results Higher ALBI, APRI, and APRI + ALBI were found in patients with postoperative morbidity (P = 0.001, P = 0.064, P = 0.001, respectively), liver dysfunction (LD) (P = 0.009, P = 0.012, P