Diagnóstico

Update in Urologic Surgery: Introduction to Robotics

2025-05-31T09:53:40-05:00

This is a paper that explains the genesis of robotic technology in general and the reasons why it was developed as
well as its advantages with prior technologies. The analysis makes a concise summary of the most frequent urologic robotic
surgeries in the world and the most salient facts about their developments and current roles. Finally, an explanation of
future directions in the field of robotic surgery is given.

Evolution and current approaches in brest and axillary surgery for the treatment of early breast cancer

2025-05-31T10:13:40-05:00

This article reviews the evolution of the surgical treatment of breast cancer, from radical mastectomy to extreme
oncoplastic surgery. Through this progression, radical axillary dissection has also been substantially transformed. Therefore,
we present the de-escalation process of axillary dissection, highlighting sentinel lymph node biopsy as the most widely accepted standard of care in cases with clinically negative nodes and negative sentinel nodes. This is because it has demonstrated comparable outcomes in terms of disease-free survival, overall survival, and low local recurrence rates when comparing axillary dissection with sentinel lymph node biopsy alone in randomized patient groups. Additionally, recent studies show that axillary dissection after neoadjuvant therapy and radiotherapy may be omitted in specific cases of patients with clinically positive nodes or positive sentinel nodes. Lastly, there is ongoing research exploring the potential to omit sentinel lymph node biopsy by combining neoadyuvant therapy, radiotherapy and preoperative ultrasound assessment. These findings underline the relevance of individualized and multidisciplinary decision making to tailor treatment for each patient. The movement towards the oncoplastic surgery and a less invasive axillary intervention is supported, aiming to reduce morbidity and complications, thus improving patients' quality of life. Further studies are required to continue assessing the efficacy of less invasive approaches.

Update on the Management of Obesity

2025-05-31T10:23:27-05:00

Obesity, recognized as a disease by the WHO in 1948, is chronic and multifactorial, affecting millions of people. It is
primarily diagnosed by a BMI over 30 kg/m², though this method has limitations. Its prevalence has tripled since 1975, with
genetic, socioeconomic, and environmental factors contributing to its development. Treatment includes lifestyle changes,
medications, and bariatric surgery, with recent advancements in pharmacotherapy showing favorable outcomes in weight loss
and cardiovascular risk reduction. Common procedures, such as Roux-en-Y gastric bypass and sleeve gastrectomy, have shown
sustained weight loss results, achieving 50-75% excess weight loss at 10 years. The SADIS bypass offers a low complication rate
and better outcomes, with more than 80% excess weight loss at 10 years. Each of these procedures has different remission rates for associated metabolic diseases. Selecting the appropriate procedure must balance effectiveness with patient safety. All of these operations allow discharge within the first 24-48 hours, with patients returning to work 5-7 days post-surgery.

Advances in abdominal surgical oncology

2025-06-03T05:29:07-05:00

The rapid technological evolution of laparoscopic and robotic surgical systems, together with the emergence of
novel and highly effective antineoplastic therapies-driven by rigorous basic and clinical research-and a refined
understanding of surgical anatomy, is continuously reshaping oncologic surgical techniques. This transformation is
characterized by the implementation of increasingly individualized neoadjuvant protocols, tailored to specific tumor
biology and patient profiles. These strategies have enabled the conversion of initially unresectable or borderline resectable
gastrointestinal tumors into resectable disease, amenable to standardized surgical resection techniques based on high
central vascular ligation and complete mesenteric excision, consistent with the organ's embryological origin.

Acute surgical abdomen

2025-05-31T10:36:25-05:00

Acute surgical abdomen is a common presentation among patients in the emergency room, necessitating timely and
accurate diagnosis and intervention by physicians and surgeons to mitigate morbidity and mortality. This narrative review
synthesizes clinical guidelines, journal papers, and recent literature to provide a comprehensive overview of the most prevalent
conditions contributing to acute surgical abdomen in our healthcare system, with a particular focus on diagnostic strategies and
definitive therapeutic approaches.

Anemia Gestacional, Anemia de Enfermedades Crónicas y Sobrecarga de Hierro

2025-05-31T10:58:04-05:00

Menciona el editor en la Presentación: “La anemia sigue constituyendo un problema severo de salud pública a nivel
mundial donde se estima que dos mil millones de personas son diagnosticadas como tal. La OMS en 1958 organiza una
reunión de expertos para discutir sobre la anemia por deficiencia de hierro que predominaba sobre todo en los países menos
desarrollados.

Convocatoria al "Premio a la Mejor Edición Científica" 2025

2025-06-18T19:09:33-05:00

Tirzepatida comparado con Semaglutida para el tramiento de la obesidad

2025-05-31T11:10:49-05:00

Tirzepatida y semaglutida son medicamentos muy efectivos para el tratamiento de la obesidad. La eficacia y la
seguridad del tirzepatida comparado con con el semaglutida en adultos con obesidad pero sin diabetes es desconocido.

Diagnosis, evolution and treatment of craneofaringiomas

2025-05-20T05:14:15-05:00

Objective: To describe the clinical and metabolic characteristics of craniopharyngiomas. Material and methods: To descriptive, cross-sectional, retrospective study of 10 cases of sellar craniopharyngiomas of those who were attended in author´s private practice, collected from january 2 to march 31, 2023. Information is given on age, weight, height, BMI, blood pressure,
concentrations of prolactin (PRL), thyrotrophic hormone (TSH), luteotrophic hormone (LH), follicle-stimulating hormone (FSH), somatotropin (STH), thyroxine (T4), triiodo-thyronine (T3), cortisol (F), testosterone (T) in men, estradiol (E2) in women, glucose (G). Stimulatory tests with TRH, GnRH, insulin hypoglycemia, x-rays, ocular campimetry and treatment. Results: 30%
women, 28.1±19,5 years old, weight 42.9±12,0 kg, height 1.35±0,12 m, BMI 23.3±3,91 BP 108.0/73.8 mmHg, PRL 26±3 ng/ml, STH 0.47±0.53 ng/ml ml, TSH 5.3±2.4mIU/L, LH 0.92±0.67IU/L, T4 4.8±3.7 ug/dl, T3 100±10 ng/dl, F 3.5 ±3 .78ug/dl, T
1.76±1.26 ng/dL, E2 15.7±6.03 pg/ml G 79.3±6.15. TRH test: 7, 2.9, 4.2 mIU/L TSH. GnRH test: 1.09, 1.95, 3.03, 3.05, 1.17 IU/L LH. Insulin hypoglycemia: 0.43, 0.62, 0.47, 0.4, 0.43 ng/ml STH; 3.5, 4.17, 6.2, 6.43, 5.47 ug/dL cortisol. All showed an increase
in the sella turcica, several with calcifications in the cystic images. The majority had vision impairment that led to blindness. They underwent transsphenoidal hypophysectomy. Two patients developed diabetes insipidus before the quirurgic treatment. Conclusions: Craniopharyngiomas had basal hormonal concentrations in the normal range and limited responses to stimulatory tests.

Update on Surgery: From open surgery to laparoscopic surgery and its transition to robotics

2025-05-31T10:51:28-05:00

Use of enoxaparin in recurrent pregnancy loss with and without thrombophilia

2025-06-27T06:33:58-05:00

Significant advances have been made in the diagnosis and treatment of recurrent pregnancy loss (RPL), however, almost half of
couples do not receive a definitive diagnosis. The presence or absence of thrombophilia has been associated with clinical outcomes in women with RPL, and there are reports of the impact of prophylactic low-molecular-weight heparin (LMWH) therapy combined with aspirin in increasing live birth rates (LBR) and preventing miscarriages. To determine the effectiveness of enoxaparin (the most widely used and available LMWH in our setting) with or without aspirin (+/- ASA) vs. Observational (+/- ASA); a rapid literature review of prophylactic enoxaparin +/- ASA in increasing LBR and preventing miscarriage in subjects with RPL with or without thrombophilia was conducted. A total of 316 publications were identified, of which 176 met the review criteria. 22 controlled studies were ultimately selected: 10 studies (population with thrombophilia), 15 studies (population without thrombophilia), and 3 studies with a mixed population. The studies did not show homogeneity in the population involved in terms of age, body mass index, history of autoimmune disease, thromboembolic disease, type of thrombophilia, acquired, congenital, or mixed, dose of enoxaparin with ASA, and the start of pharmacological intervention. In subjects with thrombophilia, the enoxaparin +/- ASA intervention was beneficial in increasing LBR (RR 2.54, Z=2.70, p=0.007) and reducing miscarriage (RR 0.32, Z=4.59, p<0.00001). In subjects without thrombophilia, the enoxaparin +/- ASA intervention was beneficial in increasing LBR (RR 1.14, Z=2.80, p=0.005) and was not effective in preventing miscarriage (RR 0.85, Z=0.91, p=0.36). The quality of evidence for biases was significant, including: random sequence bias (45%), allocation concealment bias (81%), performance bias (86%), and detection bias (31%). Despite the heterogeneity of the studies in this rapid review, it can be observed that enoxaparin +/- ASA was effective in increasing LBR in RPL with and without thrombophilia, while it was only effective in preventing miscarriage in RPL with thrombophilia. Controlled studies with broad thrombophilia laboratory panels, similar doses of enoxaparin and ASA, monitoring, and a common starting time are needed.