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Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyse a series of cataract surgeries performed in a third-fourth level teaching hospital, providing complementary data to the number of surgeries that can be used as a further reference, and to compare them with those published by other Public Health Systems, mainly the British one., Methods: Retrospective study of 1052 cataract procedures at the University Hospital of Valladolid from January 2016 to July 2016. Collected variables: age, gender, pre- and postsurgical visual acuity, degree of complexity of the cataract, duration of the surgery, and surgical complications., Results: The mean age of the patients was 74.1 ± 9.5 years, and 81.61% started from a VA <0.5. The duration of the surgery was collected only in 12% of the procedures. The complications rate was 1.8%, with one case of endophthalmitis. A final postoperative refraction was performed in only 44.7% of the cases. A total of 87.2% of the eyes achieved a VA ≥ 0.5 after surgery., Conclusions: The results of the series show significant differences from those from the audit of the English National Healthcare System, with our patients being more complex and having less complications. There are missing-data in the collection of important variables such as post-surgical refraction or the duration of the surgery, which despite this, this work can be a good reference., (Copyright © 2019 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals., (Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied., Material and Methods: A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed., Results: A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P=.044), the change in the quality of life due to the symptoms (P=.028), and expectations (P<.001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P<.001)., Conclusions: The level of patient dissatisfaction is associated with expectations about time in waiting list., (Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: The complaints to a medical service are a measure of the quality of health care perceived by the patients. The aim of this study was to analyse the differences found in the percentage of complaints made to the General and Gastrointestinal Surgery Department (GGSD) with the changes made due to moving to a new hospital., Material and Methods: A longitudinal study of the percentage of complaints made to the GGSD in two 6 month periods in the same year (periods A and B). The Department was moved to a new hospital between the two periods. The percentage complaints associated with the hospital and outpatient activity is compared., Results: The percentage complaints made to the GGSD was 3.02% directed at the hospital service and 0.44% to outpatient care. When both periods were compared, a statistically significant difference was observed in the hospital complaints (A: 3.74% vs B: 2.20%, P=.006) and in the outpatient complaints (A: 0.53% vs. B: 0.34%, P=.005). It could also be shown that there was a continuous significant correlation in the parallel decrease in the hospital and outpatient complaints (R:0.988 P<.001)., Conclusions: The structural and functional change due to moving to a new hospital showed that the percentage of complaints made to the GGSD changed significantly in the period studied. Prospective multicentre studies are required to evaluate whether these results can be extrapolated to other services., (Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: Intrathyroidal parathyroid adenomas (IPA) are a not an uncommon cause of persistent hyperparathyroidism. There is no consensus on their prevalence, embryological origin and position within the thyroid., Patients and Method: Retrospective review of prospectively recorded surgical protocols of patients having had parathyroidectomy for primary (n = 437) or secondary (n = 137) hyperparathyroidism by the same surgeon. Cases with IPA were identified and the following data were recorded: age, most probable embryological origin, position within the thyroid (side and height), results of imaging techniques and surgical implications., Results: Seventeen IPA were detected in 16 patients (6M, 10F, prevalence 3.2%); 9 belonged to IIIP and 8 to IVP. Three lower IPA were supernumerary glands. Eight IPA were included within the right lower thyroid lobe. Twelve IPA (70.6%), were found during the initial parathyroidectomy: 3 were enucleated and 9 were treated with a partial thyroidectomy or hemithyroidectomy. Of the 3 enucleations, 2 had a local benign recurrence due to an incomplete capsule resection. No patients treated with thyroidectomy had a recurrence. The remaining 5 IPA, found in 4 patients, were not identified initially and caused persistence of the disease leading to 5 reinterventions., Conclusions: IPA are present in 3% of patients submitted to parathyroidectomy. They predominate in the right thyroid lobe and can be IIIP, IVP and supernumerary. They often cause persistence. Thyroid resection affords the best results since complete enucleation can be difficult and leaving behind a fragment of the IPA results in local recurrence.

Introduction: To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay., Patients and Methods: We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints., Results: A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1%) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P < .001)., Conclusion: SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days.

Introduction: Secondary renal hyperparathyroidism (SHPT) affects nearly all patients on regular hemodialysis. Between 5% and 10% will need surgery to control the disease. Despite a meticulous technique, the rate of recurrent/persistent hyperparathyroidism after surgery remains between 2% and 12%., Patients and Method: We reviewed the reoperations of 7 patients with recurrent or persistent SHPT from a series of 56 patients, 3 of which were referred from other units for treatment of recurrence. Subtotal parathyroidectomy (ST-PTX) was performed in 51 patients and total parathyroidectomy with autograft (TPTX-AT) was performed in the remaining 5 patients., Results: Seven patients underwent reoperation for recurrent SHPT, 1 of them twice (8 reinterventions in 56 patients). In 2 patients only 3 parathyroid glands were removed at the first intervention and recurrence was due to the presence of a fourth gland. In 4 patients, ST-PTX was performed and recurrence was due to a remnant hyperplasic area in 1 and to a fifth gland in 3. Recurrence in the patient with a TPTX-AT was to due to cervical parathyromatosis. All the patients with recurrence had a positive preoperative Tc-MIBI scintigraphy and the computed tomography/magnetic resonance examination was highly useful for anatomical localization of the lesion and for planning the surgical approach.

Case Report: We report a case of sympathetic ophthalmia (SO) developed after blunt trauma and vitrectomy (complicated with a massive suprachoroidal hemorrhage) using perfluorocarbon liquid (PFCL) for tamponade., Discussion: The presentation of SO in a vitrectomized patient after severe blunt trauma with extended intra-ocular tamponade with PFCL could support the hypothesis that chronic inflammation caused by PFCL could have contributed to the development of SO. Nevertheless, there are other possible causal factors such as the trauma, the vitrectomy itself or the choroidal detachment with possible uveal incarceration at wound sites.

Case Report: A 33 year-old female with an asymptomatic pigmented mass in the iridocorneal angle of her right eye, arising from the ciliary body is presented. Ciliary body melanocytoma was suspected and conservative management recommended. After 36 months of follow-up the patient developed pain, inflammatory reaction and uncontrollable ocular hypertension, which was diagnosed as melanocytomalytic glaucoma. Tumor was removed by external iridecyclectomy and the histopathologic findings revealed necrotic melanocytoma., Discussion: Ciliary body melanocytoma is a rare benign pigmented tumor that may present extension to the anterior chamber. Differential diagnosis mainly includes ciliary body melanoma, which carries a different prognosis and treatment.

Purpose: To evaluate the usefulness of silicone-fluorsilicone copolymer oil (SiFO) as an intraoperative tool and a vitreous substitute in vitreoretinal surgery., Methods: Handling properties of SiFO were tested and compared with those of perfluorooctane (PFO). The transparency of both substances was measured by spectrophotometry and subjectively assessed. Their tendency to dispersion was observed during injection in balanced saline solution (BSS) and after mechanized and manual shaking. Ease of injection and aspiration through small-gauge instruments was evaluated. Ocular tolerance to SiFO and PFO was studied after intravitreal injection in rabbit eyes: intraocular pressure, anterior segment inflammatory response and dispersion were evaluated, and a histopathological study was performed., Results: Injection and aspiration of SiFO were more difficult than those of PFO because of its higher viscosity. PFO dispersed progressively into small droplets as early as two days after intravitreal injection, whereas SiFO remained as a single bubble for 14 days. Histopathologically both substances induced an inflammatory response over the inferior retina, with microvacuolated macrophages and foreign body giant cells, which were larger in eyes wearing SiFO., Conclusions: SiFO may be useful as an intraoperative tool, although its main drawback is a more difficult injection and aspiration compared to PFO. It has been well tolerated as a short-term vitreous substitute, but further clinical studies are needed.

Purpose: To establish the incidence, evolution and final visual outcome of corneal epithelial complications after vitrectomy in a consecutive series performed throughout a period of one year., Methods: 195 consecutive medical records of patients vitrectomized in 2001 have been retrospectively reviewed. Patients were clinically evaluated the day after vitrectomy, during the first week, and then weekly for 3 months (minimum follow-up). Functional results have been established at the end of this period., Results: 12 out of 195 eyes developed corneal epithelial complications after surgery (6.1%). Eight cases were diagnosed of persistent epithelial defect (4.1%), and four cases (2%) of necrotizing herpetic keratitis. Six out of 12 were diabetic. Corneal epithelial complications affected 10.5% of diabetic and 4.3% of non-diabetic patients (p=0.10). The majority of persistent epithelial defects healed without sequelae in less than two months. Herpetic keratitis required between 3 to 4 months to heal and caused corneal scarring in all cases., Conclusions: Persistent corneal epithelial defects after vitrectomy are a relatively frequent complication, mainly in diabetic patients. Recurrence of herpetic keratitis must also be kept in mind. This finding has not been previously reported and needs further studies.

Objective: To know in a quantitative manner the degree of discomfort and pain of the biopsies of the prostate and to evaluate the effectiveness of the transrectal lidocaine., Material and Method: We performed 140 transrectal biopsies of the prostate, Patients were included on a random basis into two arms: one of them received intrarectal lidocaine, 20 mg (group 1, n = 71) and the other group received placebo (group 2, n = 28) both of them ten minutes prior the proceeding., Results: The global pain mean was 3.7 (0 no pain, 10 highest pain) and the global discomfort mean was 3.5. The group 1 patients showed a trend to feel less pain and discomfort although it did not reach the necessary statistic significance (p = 0.7 y p = 0.5 respectively)., Conclusions: We do not achieve the good results obtained by other groups in order to decrease the degree of pain and discomfort with the use of intrarectal lidocaine. We did not find relationship between the PSA level, previous biopsies, intrarectal lidocaina and degree of information received and the degree of pain and discomfort.

Purpose: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management., Methods: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases., Results: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached., Conclusions: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy.

Clinical Cases: We report two cases of SO (sympathetic ophthalmia) among 1,456 vitrectomies and 255 silicone oil injections performed since 1990. In both patients intraocular silicone oil was used. Both cases were clinically documented and one pathologically demonstrated., Discussion: No cases were reported among vitrectomies without silicone oil. We found a longer delay between injury and the onset of the disease in comparison to the literature. Pathological findings confirmed a foreign body granulomatous reaction. Chronic inflammation caused by silicone oil might be involved in the development of SO. Larger series are necessary to establish a possible relationship between silicone oil and SO.

Purpose: To investigate the possibility of classifying RD patients in different risk groups according to their probability of developing PVR., Methods: This retrospective study included 298 RD patients who underwent RD surgery, with either no PVR or with PVR grade B or less. Risk factors were evaluated by single and multiple logistic regression analysis to obtain risk factors of PVR. According to the results of the regression analysis, a score was applied to the different risk factors. The sum of these scores provided a final score for each patient, which was used to divide patients in three groups according to their risk of developing PVR., Results: By multiple logistic regression analysis, the following risk factors for developing PVR were identified: Preoperative PVR grade A or B, RD involving 4 quadrants, previous intraocular surgery, endolaser application, and intraocular gas injection. Three protective factors were also identified: RD in the fellow eye, postoperative ocular hypertension, and total reattachment 24 hours after surgery. Patients were divided in three groups according to their probability to develop PVR: Low risk (192 patients, 11.5% developed PVR), moderate risk (70 patients, 50.0% developed PVR) and high risk (36 patients, 80.6% developed PVR)., Conclusions: It is possible to ascribe patients to a low, moderate or high risk probability of developing PVR and these data could be useful to establish a prophylactic treatment for PVR. A larger and prospective study is needed to corroborate these data and to obtain new indicators.

Objective: Apert syndrome is one of the five craniosynostosis syndromes caused by allelic mutations of the fibroblast growth-factor receptor 2 (FGFR2). It is characterized by symmetrical cutaneous and bony syndactyly of the hands and feet and a variety of pleiotrophic features of the skeleton, central nervous system, skin and internal organs., Patients and Methods: We show the clinical and epidemiological characteristics of the 17 cases of Apert syndrome identified in a consecutive series of 26,956 malformed liveborn infants detected among 1,502,639 livebirths surveyed by the Spanish Collaborative Study of Congenital Malformations (CEMC) between April 1976 and March 1998., Results and Conclusions: The estimated frequency of Apert syndrome in Spain is 0.11 per 10,000 liveborn infants. All of the cases were sporadic and were associated with an increased paternal age. The clinical manifestations of our cases are concordant with the variable expression of the syndrome, with the cardinal features of acrocephaly secondary to craniosynostosis and syndactyly of hands and feet present in all cases, and other anomalies, including cardiovascular (23.5%), cleft palate (23.5%), urinary (5.9%) and central nervous system (5.9%), in some of the patients.

Objective: Steinert's congenital myotonic dystrophy (CMD) is a systemic disease with autosomal mother-to-child transmission and characterized by generalized hypotonia, areflexia, facial diplegia, respiratory and alimentary diseases, arthrogryposis, polyhydramnios, etc. We present the study of the clinical and epidemiological characteristics of Steinert's CMD in our population, with special attention to its dysmorphological features., Patients and Methods: In this study we present the analysis of 12 cases of Steinert's CMD identified among 26,956 infants with congenital defects registered by the Spanish Collaborative Study of Congenital Malformations (ECEMC) between April 1976 and March 1998., Results: The minimum estimation of the prevalence in our population is 0.08 per 10,000 live births. We have epidemiologically observed in newborns with Steinert's CMD the presence of a statistically significant difference in the following variables: lower gestational age and birth weight, more polyhydramnios, more feet presentations and Cesarean sections, and a higher frequency of similar congenital defects in first degree relatives. The congenital defects most frequently associated to our population of CMD are located in the extremities, the head and face., Conclusions: It is important to recognize the congenital defects associated with neuromuscular disorders in the neonatal period, and particularly, the wide spectrum of Steinert's CMD that results in a fetal hypokinesia deformation sequence.

Objective: Wiedemann-Beckwith syndrome is a multisystemic pattern of congenital anomalies with overgrowth. The most characteristic clinical features are macroglossia, high birth weight, omphalocele, visceromegaly and hypoglycemia., Patients and Methods: We show the clinical and epidemiological characteristics of the 18 cases with Wiedemann-Beckwith syndrome identified in the consecutive series of 25,967 malformed liveborn infants detected among 1,431,368 livebirths surveyed by the Spanish Collaborative Study of Congenital Malformations (ECEMC) between April 1976 and June 1997., Results and Conclusions: The minimal estimated frequency of Wiedemann-Beckwith syndrome in Spain is 0.13 per 10,000 liveborn infants. These infants have a high birth weight for their gestational age and are born of shorter pregnancies (prematurity 33.3%). The clinical manifestations of our cases are concordant with the variable expression of the syndrome; the most frequent features were macroglossia (100%), omphalocele or umbilical hernia (77.8%) and high birth weight (64.7%). Other findings were polyhydramnios and placentomegaly. All of the cases were sporadic.

Objective: To describe the clinical and histopathological manifestations of a case of pseudoepitheliomatous, keratotic and micaceous balanitis and review the literature on this rare condition., Methods: A case of pseudoepitheliomatous, keratotic and micaceous balanitis in a 63-year-old man is presented. The lesion appeared a few months after undergoing circumcision due to phimosis and recurrent inflammatory balanitis., Results: The lesion relapsed after topical treatment with 5-FU, cryotherapy and shaving-biopsy plus electrocoagulation. It was finally diagnosed as epidermoid carcinoma and surgically excised., Conclusions: The clinical and histopathological features, course and relationship between micaceous balanitis and carcinoma of the penis are reviewed.

Objective: Jarcho-Levin syndrome is characterized by the presence of only costal-vertebral defects. However, this diagnosis has been used in any case presenting with costovertebral defects, whether associated to other congenital defects or not. Recently, it has been demonstrated that costovertebral defects constitute a developmental field defect and, because of this, they can be observed in different clinical and etiological patterns. On the other hand, Casamassima syndrome is characterized by the presence of costovertebral defects, genito-urinary anomalies and anal atresia, which make it easily distinguishable from Jarcho-Levin syndrome., Patients and Methods: We present the cases with Jarcho-Levin and Casamassima syndromes identified among 1,405,374 liveborn (LB) infants registered by the Spanish Collaborative Study of Congenital Malformations (ECEMC)., Results: Frequencies of these two syndromes in the ECEMC are 0.2 per 100,000 LB for Jarcho-Levin syndrome and 0.3 per 100,000 LB for Casamassima syndrome. We present the clinical manifestations and other characteristics of all the cases registered with these syndromes in the ECEMC., Conclusions: Jarcho-Levin syndrome is defined by the presence of costoveriebral defects without any other congenital defect. However, given that the alterations of the axial skeleton are a developmental field defect, they can be observed in different clinical-etiological patterns that should not be considered as Jarcho-Levin syndrome. Among these, Cassamassima syndrome can be clearly distinguished, being autosomal recessive as is Jarcho-Levin syndrome.

Background: Most published papers on women with a bicornuate uterus analyze their fertility problems, as well as certain pregnancy complications. We have not found any epidemiological study on the infants of mothers with this uterine malformation. Only in some papers a reference is made about the relationship of maternal bicornuate uterus with congenital deformations and disruptions in their infants., Patients and Methods: Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), which has a case-control methodology, some characteristics in a series of 26,945 malformed infants, such as birth weight, sex, gestational age, umbilical cord length, placental weight and maternal age, were analyzed by separating infants of mothers with normal uterus and those of mothers with a bicornuate uterus., Results: Results showed that women with a bicornuate uterus have more daughters than sons and an increased risk for intrauterine growth retardation and prematurity with respect to infants of mothers with a normal uterus. On the other hand, the risk of having an infant with congenital defects is higher for women with a bicornuate uterus than for those with a normal uterus., Conclusions: Pregnancies of women with a bicornuate uterus have to be considered at risk since they have more risk for complications and for having an infant with congenital defects, premature birth and with intrauterine growth retardation.