Resumen: El objetivo de este estudio fue analizar las acciones del combate de taekwondo de alto nivel masculino en las 8 categorías de peso o ciales (Minimosca: <54kg, Mosca: 54-58kg, Gallo: 58-62kg, Pluma: 62-67kg, Ligero: 67-72kg, Superligero: 72-78kg, Medio: 78-84, Pesado: >84kg) en competición. Se diseñó un instrumento de observación ad hoc vinculado a un nuevo instrumento de registro (Drewtina 23), que analizaba las acciones realizadas en los combates. Los criterios de estudio fueron: el tipo de acción ofensiva y acciones defensivas, las acciones técnicas y los asaltos del combate. La observación se realizó en las nales de 6 campeonatos y copas del mundo del 2000 al 2008, con un total de 48 combates de 71 taekwondistas. Para el análisis estadístico descriptivo e inferencial se utilizó el programa PASW Statistics para Windows, y para el análisis de retardos el SDIS-GSEQ. Los resultados revelan que las acciones ofensivas tienen una mayor frecuencia que las defensivas, siendo el contraataque la ofensiva más utilizada. El peso Medio es el que más ofensivas realiza y el Superligero el que más defensivas. La media de acciones por asalto y combate es más alta en el tercer asalto. Más del 95% de las veces los combates se resuelven al nalizar el tercer asalto. El análisis secuencial de retardos muestra que las acciones ofensivas actúan como favorecedoras de las acciones e caces y las defensivas como inhibidoras. La ventaja en el marcador actúa como inhibidora de las acciones ofensivas y excitadora de las defensivas en todas las categorías de peso. Palabras clave: Acciones tácticas, acciones técnicas, asaltos, metodología observacional, análisis secuencial de retardos. Abstract: e aim of this study was to analyze the actions of male taekwondo combat at high levels in the 8 o cial weight classes (Mini yweight: <54kg, Flyweight: 54-58kg, Bantamweight: 58-62kg, Featherweight: 62-67kg, Lightweight: 67-72kg, Super lightweight: 72-78kg, Middleweight: 78-84, Heavyweight: >84kg) in competition. An observation instrument was designed ad hoc, binded to a new recording instrument (Drewtina 23), which analyzed the actions taken out in combat. e study criteria were: the kind of o ensive and defensive actions, technical actions and combat assaults. e observation was carried out at the nals of 6 championships and world cups from 2000 to 2008, for a total of 48 combats, involving 71 ghters. For the descrptive and inferential statistical analysis, PASW Statistics for Windows was used, and for the lag sequential analysis, SDIS-GSEQ was used. e results show that the o ensive actions are more frequent than defensive ones, since counter-attack is the most utilized technique. e Middleweight class is characterized by the highest number of o ensive actions, while the Superlightweight class is characterized by the highest number of defensive ones. e mean of actions for assault and combat is higher during the third time. More than 95% of the times, the ghts are resolved at the end of the third time. e lag sequential analysis show that o ensiv...

Introduction Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.

Introduction The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.

El melanoma primario de vesícula biliar (VB) es una entidad infrecuente a debate. Se han propuesto criterios diagnósticos para identificar esta lesión. Presentamos el caso de una mujer de 60 años sin antecedentes de interés con sospecha de neoplasia de VB que se somete a cirugía. Se evidencia lesión polipoidea melanocítica única con componente de unión. Se descartan lesiones sincrónicas melanocíticas. Los criterios diagnósticos propuestos son: exclusión de melanoma primario previo, ausencia de presencia de lesiones sincrónicas, lesión única, lesión papilar o polipoidea y presencia de un componente melanocitario de unión. No obstante, la mayoría de la literatura no cumple con estos criterios.

No abstract