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Jerez de la Frontera, Spain

Villar J.M.,Virgen Of Las Nieves Universitary Hospital | Moreno P.,Bellvitge Universitary Hospital | Ortega J.,Clinico Universitary Hospital | Bollo E.,Donostia Hospital | And 16 more authors.
Langenbeck's Archives of Surgery | Year: 2010

Purpose: Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments. Methods: Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05. Results: Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p∈=∈0.008), more malignant lesions treated (p∈=∈0.03), a shorter overall stay (p∈<∈0.0001), and a shorter stay after laparotomic adrenalectomy (p∈=∈0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p∈=∈0.02). Conclusions: In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidty and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay. © 2010 Springer-Verlag. Source


Medvedofsky D.,University of Chicago | Addetia K.,University of Chicago | Hamilton J.,Epsilon Imaging | Leon Jimenez J.,Jerez de la Frontera Hospital | And 2 more authors.
International Journal of Cardiovascular Imaging | Year: 2015

Although parameters of right ventricular (RV) size and function are clinically important, echocardiographic assessment of this chamber is complex. Existing quantitative approaches rely on manual measurements performed on different images, and are thus time-consuming. Consequently, in clinical practice, qualitative assessment is usually used instead. We tested a new approach for automated measurements of RV size and function using speckle tracking by comparing them to the conventional manual methodology. Transthoracic images were obtained in 149 patients with a wide range of RV size and function, and were analyzed by an expert using conventional techniques to obtain RV end-diastolic and end-systolic areas, fractional area change, dimensions (basal and mid-cavity diameters and length), tricuspid annular plane systolic excursion and peak systolic velocity. Same parameters were obtained using the semi-automated software (Epsilon Imaging), which requires tracing of the RV endocardial boundary in a single frame in the RV focused view. Fifteen patients were excluded due to image quality (90 % feasibility). Time required for the automated analysis was approximately 30 s per patient, compared to 4 min for conventional analysis. The parameters obtained with the semi-automated approach were in good agreement with manual measurements: r-values 0.79–0.95 for RV size and 0.70–0.74 for function indices and biases of 2–22 % of the mean measured values, which were comparable to the intrinsic variability of the conventional technique. In conclusion, the semi-automated technique is feasible, fast and provides quantitative parameters of RV size and function, which are comparable to conventional measurements. © 2015, Springer Science+Business Media Dordrecht. Source

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