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RESUMEN Objetivo: Describir las primeras intervenciones mediante cirugía hepática extrema en nuestro hospital, así como las reflexiones surgieron entorno a ellas. Material y métodos: Se recogieron datos los sobre los pacientes, intervención e ingreso en la Unidad de Cuidados Intensivos de los 4 pacientes que fueron intervenidos entre noviembre de 2017 y enero de 2019. Resultados: La tasa de complicaciones/acontecimientos adversos en esta serie fue relativamente baja y prácticamente en todos los casos se resolvieron antes del alta de la unidad de cuidados posquirúrgicos. Ninguno de los pacientes con hígado macroscópicamente normal presentó signos clínicos/analíticos de disfunción hepática. Conclusiones: La cirugía hepática extrema parece una opción terapéutica factib le para pacientes que previamente se habrían considerado candidatos únicamente a tratamientos paliativos, aunque todavía es preciso definir claramente los límites de la evolución normal en los primeros días tras la intervención y su perfil de acontecimientos adversos tardíos y mortalidad. Palabras clave Neoplasias hepáticas, complicaciones posoperatorias, estudio observacional (DeCS) SUMMARY Objective: To describe the first extreme liver surgery cases in our hospital, as well as the reflections that arose around them. Material and methods: Data about the patients, operation and admission to the Intensive Care Unit of the 4 patients who were operated on between November 2017 and January 2019 were collected. Results: The rate of complications/adverse events in this series was relatively low and in almost all cases resolved before discharge from the post-surgical care unit. None of the patients with macroscopically normal liver presented clinical/analytical signs of liver dysfunction. Conclusions: Extreme liver surgery seems a feasible therapeutic option for patients who would have previously been considered candidates for palliative treatments only, although it is still necessary to clearly define the limits of normal evolution in the first days after the operation, and its profile of late adverse events and mortality.

Introducción: muchos de los pacientes que son encontrados fuera del hospital del ámbito hospitalario por el personal sanitario de emergencia con insuficiencia respiratoria grave, requieren una intubación endotraqueal rápida y eficaz que permita disminuir el riesgo de fallecimiento. El objetivo de este estudio es analizar los factores predictivos de intubación endotraqueal difícil (IED) en el medio extrahospitalario. Pacientes y Métodos: se trata de un estudio observacional y retrospectivo. Se analizaron el registro de las asistencias realizadas por el servicio de emergencias médicas de un centro hospitalario de alto nivel entre el periodo 2008-2014 que requirieron intubación endotraqueal Resultados: fueron 402 pacientes a los que se les realizó intubación orotraqueal. La tasa global de éxito fue del 100%. Las variables independientes que se asociaron a una IED fueron: lengua grande en 10 casos (45.5%) p<0.001, apertura bucal limitada 12 casos (54.5%) p<0.001, cuello corto 15 casos (68.2%) p<0.001 y cuello ancho 12 casos (54.5%) p<0.001. Conclusiones: El presentar una apertura bucal limitada, una lengua grande, un cuello corto o ancho y una movilidad cervical limitada se asocian a una intubación endotraqueal difícil en el medio extrahospitalario. Palabras clave: intubación endotraqueal, extra-hospitalaria SUMMARY:Background: many of the patients who are found outside the hospital by emergency health personnel with severe respiratory insufficiency, require a rapid and effective endotracheal intubation that reduces the risk of death. The objective of this study is to analyze the risk factors of difficult endotracheal intubation (DEI) in the pre-hospital setting. Methods: it is an observational and retrospective study. The assistance performed by the medical emergency service of a high-level hospital center between 2008 and 2014 that required endotracheal intubation was analyzed.Results: there were 402 patients who underwent orotracheal intubation. The independent variables that were associated with an DEI: large tongue in 10 cases (45.5%) p <0.001, limited oral opening 12 cases (54.5%) p <0.001, short neck 15 cases (68.2%) p <0.001 and wide neck 12 cases (54.5%) p <0.001.Conclusions: the presentation of a limited oral opening, a large tongue, a short or wide neck or limited cervical mobility are associated with a difficult endotracheal intubation in prehospital setting.

percentage involved also vision, skin and respiratory system. 49% of reports were from doctors, 30% from pharmacists, 15% from other health worker and last 6% patients. 35 (51%) AEFIs were from first dose, 32 (46%) from second and 2 (3%) form third. Almost all reports involved age range 18-64. Conclusion and RelevanceResults on Comirnaty are in line with AIFA's and regional ones; Spikevax and Vaxzevria show altered percentage because of little number of reports. Reporting rates are comparable. Most of reports concerned not severe reactions, mainly related to site of injection. It is important to underline the essential role of vaccine vigilance to identify red flags for public health in order to contain main severe reactions.