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Aim Traumatic evisceration in politrauma patients is rare, with a prevalence of 1 in 40,000 trauma patients. The main mechanism is high-energy trauma to an acute surface. Our objective is to apply theoretical knowledge regarding the complex abdominal wall as an independent entity, analyzing the particular case of a patient operated in our center. Material and Methods Description of a clinical case using data extracted from the electronic medical record and bibliographic search in Pubmed. Results The reviewed literature was applied to a traumatic evisceration case with a Grade IV on the Dennis Abdominal Trauma Scale. The decisions made during the different stages in the multidisciplinary management of the traumatic evisceration were discussed. The role of Negative Pressure Therapy, the use of biological meshes, full thickness grafts and / or the Posterior Separation of Components were used to achieve a continent and functional abdomen after an injury of that magnitude during a 4-year follow-up with excellent results. Conclusions At the moment there is no consensus on the management of these traumatic evisceration situations. It depends in many cases on the experience of the surgeon. These cases should be treated individually based on the size and location of the lesions. The approach must be carried out in different stages, always thinking about achieving an early closure of the abdomen and preserving the anatomy of the abdominal wall. The best strategy for open abdomen reconstruction is not well defined, but we believe that Posterior Component Separation is a good option.

Summary: Background: Assessment of local relapse in patients treated with surgery for breast cancer. Materials and methods: This observational study included 673 patients treated with surgery for breast cancer between 2005 and 2010, who were monitored for a 7-year minimum follow-up period. The study was concluded on 2017 and yielded a total of 31 cases of local relapse. Results: 4.6% of patients presented local relapse, most of them during the first 3 years of follow-up; 45% of patients with local relapse subsequently presented the disease at distant points. The association between the occurrence of local relapse and later onset of the disease at distant points was significant. The Kaplan–Meier survival analysis revealed that negative results for the presence of progesterone receptors, the use of neoadjuvant chemotherapy and the presence of the disease at distant points were factors that significantly influenced patient survival. Conclusions: Almost half of the patients suffering relapse subsequently present the disease at distant points. Certain factors increase the aggressiveness of the disease, predict higher risk of relapse and determine its prognosis. Keywords: Breast cancer, Local recurrence, Survival, Predictive factor

Patient diagnosed with Crohn's disease (CD) underwent urgent surgery for intestinal obstruction. Intraoperatively, an ileal stenosis causing the obstruction was observed. The pathological anatomy revealed a small bowel adenocarcinoma on Crohn's disease. Although the association of carcinoma and CD is very rare, we consider important to have a high level of suspicion in order to achieve early management of these patients and to improve the poor prognosis of this disease.

A 41-year-old female patient was under study for abdominal pain located in the epigastrium and mesogastrium with no other associated symptoms. There was no record of previous episodes of pancreatitis and she denied abdominal trauma and laboratory tests were normal. A computed tomography (CT) scan was performed.

Introduction Non-sustained ventricular tachycardias (NSVT) are observed frequently among ICD patients with left ventricular dysfunction (LVD). Purpose To analyze the relationship between episodes of NSVTs and monomorphic VTs (MVTs) that subsequently cause appropriate therapies. Methods 416 ICD patients with LVD (LVEF Results During the follow-up, 1441 MVT occurred in 183 patients. After showing a significant correlation between burden of NSVT and the occurrence of appropriate therapies due to MVT (C coefficient=0.68; p5 NSVT presented an excess of adjusted risk: HR=1.97 (95% CI=1.45–2.72); p Among patients who presented NSVTs and MVTs (n=145 subjects), we analyzed the relationship between the adjusted mean CL of the NSVTs (n=1288 episodes) and the CL of the first appropriate therapy due to MVT occurring subsequently. We found a significant and positive correlation between the two (r=0.88; p5 NSVTs (r=0.97, n=52)). The robustness of such correlation was similar in individuals with ischemic (r=0.86; n=91) versus non-ischemic cardiomyopathy (r=0.90; n=54), and in primary (r=0.86; n=75) versus secondary prevention (r=0.90; n=70). The agreement between the CL of first MVT and the adjusted mean CL of NSVT episodes (GEEM) was determined according to the Bland-Altman Method. The difference between the two values was 2±8.3 ms, with only 7.6% (11/145) of patients in whom the difference between the two CL was outside the concordance limits. The agreement was greater, again, in individuals with >5 NSVTs. As shown in the Figure, in more than 95% of patients both values were within the interval of agreement (0.32±4 ms). Conclusions 1-The burden of NSVTs occurring early after an ICD implant, but not their CL, is associated with a higher incidence of appropriate therapies due to MVT at follow-up. 2-The CL of the NSVTs and that of the first and subsequent MVTs is virtually the same in patients with higher NSVT burden. Therefore, it could be the same tachycardia, but with different duration. Figure 1 Funding Acknowledgement Type of funding source: None

Background Post-mastectomy radiotherapy reduces the risk of local-regional relapse and distant disease, and increases global survival in women with axillary involvement. With the new reconstruction techniques and increasing use of directed external radiotherapy, immediate reconstruction can be performed with good cosmetic results and low complication rates. Materials and methods Observational study with consecutive sampling conducted in patients undergoing reconstructive surgery for breast cancer, between 2010 and 2016, with a 12-months minimum follow-up period. A group of patients radiated after receiving an expander (RT-Expander) were compared with a control group of non-radiated patients (Non-RT), who had been treated with the same surgical technique. We compare general complications, reconstruction failure, aesthetic results and satisfaction degree with software IBM® SPSS® Statistics v. 21 and BREAST-Q scores. Results Reconstruction failure was observed in 15.6% of patients in a similar proportion in both groups. External radiotherapy was not an independent significant factor influencing the occurrence of general complications, capsular contracture grade ≥3 or reconstruction failure. The Kaplan-Meyer curve showed no differences in reconstruction survival between groups. Aesthetic results were excellent-very good in 78.1% of patients. Absence of a contralateral procedure for symmetrization, occurrence of general complications, occurrence of capsular contracture grade ≥3 and reconstruction failure were significantly associated to fair-poor cosmetic results. The satisfaction degree of operated patients was similar in both groups. Conclusions The evolution of external radiotherapy towards more directed techniques, which modulate the dose administered to the mammary tissue and adjacent structures, allowed us to make immediate reconstruction a reality for most patients, with complication rates, cosmetic results and satisfaction degrees similar to those of non-radiated patients.

Traumatic diaphragmatic hernia is an infrequent form of diaphragmatic disease. We present the case of a complicated right diaphragmatic hernia after right hepatectomy.

Introduction: Health professionals are asked to promote health, especially organ transplantation; however, they do not always have specific training. Objective: To analyze information about donation and organ transplantation among Spanish medical students. Method: The population under study is medical students in Spanish universities using the database of the International Donor Collaborative Project, stratified by geographic area and academic year (n = 9275). The instrument used is the attitude questionnaire for organ donation for "PCID-DTO-Ríos" transplantation, validated with an explained variance of 63.203% and α = 0.834. The Student t test was applied together with the χ2 test, complemented by an analysis of the remainders, and Fisher's exact test was applied. Results: Of the students, 74% indicate that they have received information from university professors about organ transplant. Concerning specific issues with the donation, it is notable that only 66.7% (n = 6190) know and accept the concept of brain death as the death of a person. However, only 22% consider themselves as having good information, and 35.3% indicate that their information is scarce or void. Students indicate having received information about transplant from other extra-university sources, such as television and Internet (80.9%), books and magazines (73.2%), and the press (66.9%). From the information obtained in the sociofamilial field, 60.7% have obtained information from the family and 58.1% from friends. Of this information, 9% has been negative from friends, 7.5% from family, 6% from the Internet and television, and 4% from university professors. Conclusion: Spanish medical students believe they have little information about organ transplantation and have received negative information. Sin financiación 1.066 JCR (2020) Q4, 160/162 Inmunology 0.373 SJR (2020) Q3, 260/456 Surgery No data IDR 2020 UEM

Introduction Despite sensitization of medical students toward the donation of organs, a non-negligible percentage of students are not in favor of donation. Objective To analyze the reasons of Spanish medical students who do not have a favorable attitude toward the donation of their own organs after death. Method The population under study is medical students in Spanish universities, using the database of the International Donor Collaborative Project, stratified by geographic area and academic year. The questionnaire completion was anonymous and self-administered. The study group is medical students with an unfavorable attitude toward organ donation. The assessment instrument used is a validated questionnaire of attitude toward the donation of organs for transplant, “PCID-DTO-Ríos.” The reasons against the donation are valued in the questionnaire through a question. Results Of the participants included in the PCID, students who are not in favor of organ donation were selected (n = 1899). Of them, 8.1% (n = 154) are against and 91.1% (n = 1745) are doubtful. The main reasons indicated are the fear of apparent death in 11.4% of respondents, fear of possible mutilation after donation in 11.1%, and religious reasons in 2.6%. Of those, 6.9% indicate other reasons but do not clearly specify the reasons, using words such as “fear” (2.5%) or “doubts about the process” (4.1%); 66.2% (n = 1257) indicated an “assertive refusal” (“I don't want to express my reasons”). Conclusion Twenty percent of Spanish medical students are not in favor of donating their organs and are not in favor of showing their reasons. Sin financiación 1.066 JCR (2020) Q4, 160/162 Inmunology 0.373 SJR (2020) Q3, 260/456 Surgery No data IDR 2020 UEM

Resumen La cirugia bariatrica es una terapia eficaz en pacientes con obesidad morbida refractaria al tratamiento medico. Mejora los parametros antropometricos, los factores de riesgo cardiovasculares y la calidad de vida. Sin embargo, la cirugia aumenta el riesgo de malnutricion proteicoenergetica y de deficit de micronutrientes, pudiendo producir complicaciones neurologicas postoperatorias como encefalopatia, ataxia o polineuropatias, o agravar una neuropatia existente. Estas complicaciones son mas frecuentes en tecnicas malabsortivas frente a restrictivas. Presentamos un caso clinico de una paciente con ataxia espinocerebelosa que se somete a una cirugia bariatrica. Se ha conseguido llevar a cabo la intervencion con exito en una paciente con ataxia e hipoalbuminemia, sin presentar empeoramiento nutricional ni neurologico a medio plazo.

Solitary fibrous tumor (SFT) is a slow-growing neoplasm that affects both sexes equally but middle-aged patients more frequently. The course of the disease is unpredictable. SFT has been described in multiple locations. We present the case of a 62-year-old patient who went to the emergency room suffering from acute urinary retention due to solitary fibrous tumor of the abdominal wall. An arteriogram was performed with the decision make embolization before surgery. The SFT is a low-grade, potentially benign tumor. But the patient must be kept under strict oncological surveillance due to its uncertain behavior.

Background Combined hepatocellular-cholangiocarcinoma is a rare primary hepatic tumour, showing both hepatocellular as well as biliary epithelium differentiation. Its diagnosis is often delayed, as it occurs in young patients without comorbidities and with non-specific symptoms. Most cases are confused with other types of cancer, especially fibrolamellar liver cancer, which is more frequent and has similar clinical and radiological features. Clinical case The case is presented of a 26 year old woman with a giant combined hepatocellular-cholangiocarcinoma with difficulties in its diagnosis and a complicated surgical approach. Discussion The definitive diagnosis of this disease is defined by the histological demonstration of cholangiolar and hepatocellular differentiation, with surgical treatment always being the best choice, but with lower survival than classic hepatocellular carcinoma and cholangiocarcinoma. In some patients with unfavourable prognostic factors, adjuvant chemotherapy mainly directed cholangiolar component can be given. Conclusion The current incidence of combined hepatocellular-cholangiocarcinoma varies from 2% to 5% of cases, and is one of the rarest histological types in the world. The large size and hypervascularisation of the tumour makes a surgical approach difficult in these patients, while the rare histological features require a more detailed study of the piece and the application of immunohistochemical techniques to confirm the diagnosis.

Introduction Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation. Objective To assess the impact of religious beliefs of medical students on their attitude toward ODT. Method Population under study: Medical students in Spanish universities. Study sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered. Results Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know. Conclusion The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation. Sin financiación 0.784 JCR (2019) Q4, 155/158 Immunology, 191/210 Surgery, 24/24 Transplantation 0.363 SJR (2019) Q3, 254/451 Surgery, 27/41 Transplantation No data IDR 2019 UEM

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs. Objective To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT. Methods and Design and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10,566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study. Results The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one's own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000). Conclusion Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training. Sin financiación 1.066 JCR (2020) Q4, 160/162 Inmunology 0.373 SJR (2020) Q3, 260/456 Surgery No data IDR 2020 UEM

Introduction: Awareness of organ donation among Spanish doctors and medical students is very positive. However, the emerging group of professionals of non-Spanish nationality studying in Spain has not been analyzed. Objective: To analyze the differences in the attitudes toward the different types of donation among medical students, according to their nationality. Methods: The population under study is medical students in Spanish universities using the database of the International Collaborative Donor Project, stratified by geographic area and academic year. Groups under study include students of non-Spanish nationality as group 1 (n = 1570) and students of Spanish nationality as Group 2 (n = 7705). Instruments are validated questionnaires of attitude toward donation "PCID-DTO-Ríos," "PCID-DVR-Ríos," "PCID-DVH-Ríos," and "PCID-XenoTx-Ríos." Results: The attitude toward the donation of own organs after death is similar in both groups (P = .703). Non-Spaniards are 79.2% in favor compared to 79.6% of Spaniards. Living kidney donation, both unrelated (33.3% vs 29.3% in favor; P = .001) and related (91.2% vs 89, 6% in favor; P = .047), is more favorable among non-Spanish students. There are no differences regarding non-related living liver donation (29.7% vs 29.3% in favor; P = .063), but there are differences in the results for related living liver donation (94.1% vs 88%; P < .001). The attitude toward xenotransplantation of organs is similar (80.8% vs 80.8%; P = .999). Conclusions: Awareness of the donation of organs among Spanish medical students is similar to non-Spanish students studying in Spain, except the attitude toward living donation. Sin financiación 1.066 JCR (2020) Q4, 160/162 Inmunology 0.373 SJR (2020) Q3, 260/456 Surgery No data IDR 2020 UEM

A primary care physician (PCP) not only accompanies the patient in the process of an illness, but throughout his or her life. The confidence we have in these health professionals is fundamental, and their favorable attitude toward organ donation and transplantation (ODT) has a significant influence on the population. Objective To analyze trust in PCPs among Spanish medical and nursing students, the relationship with their attitude toward ODT, and the factors that condition it. Methods and Design A sociologic, multicenter, and observational study. Population: medical and nursing students in Spanish universities. Database: Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students (99% confidence and precision of ±1%), stratified by geographic area and year of study. Results Completion rate: 90%. With respect to students’ trust in their physician, 18% (n = 3267) of them totally trust (completely), 45% (n = 8101) trust enough, 30% (n = 5478) of them have not enough trust, and 7% not at all. Comparing groups, medical students totally trust more in PCPs than nursing students (55% vs 45%; P < .000), however, nursing students have less than enough trust in their PCP than medical students (53% vs 47%; P < .000). Students that totally trust in their PCP were more in favor toward ODT than students with not enough trust (83% vs 77%; P < .000). Conclusion Only 18% of Spanish medical and nursing students totally trust in their PCP. Attitude toward ODT is related to a higher level of trust in PCPs among these students. Sin financiación 1.066 JCR (2020) Q4, 160/162 Immunology 0.373 SJR (2020) Q3, 260/456 Surgery No data IDR 2020 UEM

Information provided by health care professionals is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), where the participation of the general public is essential to obtain organs. Objective To determine the attitude toward the Law of Presumed Consent (LPC) among Spanish university students and to analyze their relation with attitude toward ODT. Methods and design. The type of study was a sociologic, multicenter, observational study. The population included medical and nursing students in Spanish universities. Database of Collaborative International Donor Project was used stratified by geographic area and academic course. A validated questionnaire (Collaborative International Donor Project, organ donation and transplantation questionnaire in Spanish [PCID-DTO-RIOS]) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students was analyzed (99% confidence and precision of ±1%) and stratified by geographic area and year of study. Results Completion rate was 90%. Regarding attitude toward LPC, 66% of the students were against the law, whereas 34% accepted it. Of the students surveyed, 9% considered the law as a gesture of solidarity, 25% as an effective way of not wasting organs, 48% as an abuse of power, and 18% as offenses against the family. Those students who were in favor of LPC also had a more favorable attitude toward ODT (86% vs 76%; P < .001). Comparing groups, nursing students were less in favor of LPC than medical students (32% vs 36%; P < .000). Conclusion Sixty-six percent of Spanish university medical and nursing students were against the LPC. The favorable attitude toward ODT is associated with considering the law as a gesture of solidarity or as an effective way of not wasting organs. Sin financiación 1.066 JCR (2020) Q4, 160/162 Immunology 0.373 SJR (2020) Q3, 260/456 No data IDR 2020 UEM

Cytomegalovirus infection is an uncommon illness that mainly affects immunocompromised subjects being associated with high morbidity and mortality rates. Reactivation or reinfection of the virus causes various symptoms ranging from asymptomatic forms to severe organ-specific complications, such as severe lower gastrointestinal bleeding. Once diagnosed the infection it is important and necessary to establish an adequate treatment with antivirals, with the surgical option for those cases with gastrointestinal complications depending on the patients clinical situation. We report two cases of immunocompromised patients that after presenting rectal bleeding, were diagnosed of cytomegalovirus colitis, requiring urgent surgery.

Introduction Antitachycardia pacing (ATP) terminates the majority (but not all) of slow VTs (S-VT) with a cycle length (CL) >320 ms. Purpose To analyze the efficacy, safety and predictors of ATP, comparing the first (ATP-1) to the second (ATP-2) and third (ATP-3) attempts. Methods We studied 556 S-VT (CL=354±18 ms; range: 321–415 ms; 1.6% syncopes) occurring in 67 patients. ATP programming was standardized, including three consecutive bursts of 15 pulses at 91% of VT CL. Results ATP effectiveness declined significantly from ATP-1 (436/556: 78%) compared to ATP-2 (24/103: 23%) and ATP-3 (10/79: 13%), p Several predictors of ATP efficacy were found by logistic regression: a) ATP-1: P-RR (OR=7.3; p Patients with a dQRS≥120 ms had a lower adjusted effectiveness of ATP and a higher proportion of S-VT causing syncope. Table. Table 1 Patients with QRS Conclusions The efficacy of ATP in terminating S-VT is mainly due to the ATP-1. The regularization of RR intervals after ineffective ATP-1 underlies the lower efficacy of ATP-2 and ATP-3. Since the dQRS correlated significantly with the PPI-CLd, patients with a dQRS≥120 ms had a lower ATP-1, ATP-2 and ATP-3 effectiveness, leading to a higher incidence of syncope.