Revista Medica Clinica Las Condes最新文献

Children are unique in anatomy, physiology, and response to different diseases. The pathologies have different presentations according to the age of the patient. Technological advances have been a great contribution in diagnosis and especially in treatment planning. This is particularly important in the field of post-resection pediatric maxillofacial reconstruction of tumor pathology. The reconstruction of a defect in the maxillofacial territory, be it maxilla or mandibular, should aim to restore anatomy (returning symmetry), function and aesthetics to the patient. The incorporation of technology through virtual planning allows to improve the predictability in relation to dental occlusion, the reconstruction of symmetry and maintaining facial contour, which are the objectives of reconstruction. As an example of the use of this technology, a case of maxillofacial pathology in an adolescent patient is presented, where a reconstruction was performed with a fibula microvascular flap.

We present the case of a 75-year-old man with metastatic sigmoid adenocarcinoma with sole left hepatic lobe lesion. After sigmoidectomy and liver metastectomy, he was referred for hepatobiliary scintigraphy (HBS), due to persistent bile leakage. The explorations were carried out with dynamic and static images.

HBS is widely used to diagnose and provide important information about biliary disruption. In this case, we were able to identify the unusual source of bile leakage in the subcapsular anterior portion of the eighth hepatic segment.

Introduction

Lingual nerve (LN) microsurgical reconstruction is an effective technique with a high success rate. Early surgery is associated with better results. Direct nerve reconstruction and graft reconstruction, whether by allograft or autograft, all present a favorable prognosis. This article presents the treatment protocol in 3 cases of microsurgical reconstruction of the lingual nerve using nerve grafts.

Case

The maxillofacial surgery team treated patients from Hospital Dr. Abraham Godoy Peña, Clínica Alemana de Temuco and Hospital Padre Las Casas (Chile). Microsurgical reconstruction by autogenous grafts was performed in 2 cases and allograft in one case; all of them showed positive results (S3+), along with functional sensorial improvemente (FSR+), and recovery of taste.

Discussion

LN surgery has been more studied in the last decade. Although many studies with different results exist, early direct reconstruction contributes to better results in FSR. The grafts are reserved for circumstances where the tension doesn’t allow a reasonable reconstruction of the LN. The autologous graft has been the gold standard, the sural nerve being the most used. The cost-benefit of using allografts has likewise been widely endorsed.

Conclusion

Autolog graft and allograft, in either early or late interventions, have excellent success rates, comparable with direct lingual nerve reconstruction. Further evaluation regarding autologous graft morbidity versus allograft costs is needed.

Currently, minimally invasive procedures are a trend in all medical fields, where minimally invasive surgery is defined as the discipline in which surgical interventions are performed in novel ways to decrease the sequelae of standard surgical dissections. The goal of minimally invasive surgery is to reduce tissue trauma, minimize bleeding, edema, and injury to adjacent tissues, thereby improving the speed and quality of recovery.

Recently, several articles have applied this concept to orthognathic surgery, where the results support that patients undergoing this type of procedure, through small incisions and minimal dissections, have less morbidity and faster post-surgical recovery.

The following article aims to review the literature and expose the minimally invasive techniques related to Le Fort I osteotomy, sagittal split ramus osteotomy and genioplasty.

Abdominal wall endometriosis is defined as the ectopic implantation of endometrial tissue on the abdominal wall. It is a rare and often overlooked condition with a poorly understood physiopathology, that generally occurs on scars from abdominal, gynecological or obstetrical surgeries. The typical clinical presentation is that of a parietal mass associated with pain accentuated by the menstrual cycle. Imaging plays a key role in the diagnosis, ultrasound in particular, since it is the first examination to be carried out in the event of suspicion of parietal endometriosis. Abdominal and pelvic magnetic resonance imaging play a key role in the diagnosis, as well as surgical planning. The definitive diagnosis is confirmed by histology.

We present the case of a patient who consulted due to cyclical pain in the left iliac fossa and in whom ultrasound and magnetic resonance imaging revealed a lesion of the anterior abdominal wall lateralized to the left suggestive of parietal endometriosis and whose diagnosis was confirmed by histology.

Introduction

Clinical simulation is an effective strategy to improve patient safety. In Situ simulation may accrue benefits by utilizing the intensive care facility, routine clinical supplies and equipment, as well as being performed during the workday.

The objective of this study was to evaluate participants’ perception of a high-fidelity in situ simulation program in an adult critical patient center.

Methods

A semi-structured anonymous survey was applied after the debriefing of the in situ simulation that evaluated the reaction of the health personnel of the adult critical patient unit of Clinica Las Condes.

Results

A total of 144 surveys were obtained during 25 simulation sessions. Most of the variables evaluated had a score above 9, interpreted as excellent or very relevant, except for the question “After this activity, do you feel more confident of your skills in a similar real case scenario?”, which presented a score of 8.65 ± 1.5. When analyzing the variables according to the role of the professional, there were only differences between nurses and nursing technicians. There were no differences between intensive care and intermediate care teams in any of the variables.

Conclusions

The participants’ perceptions with regards to in situ simulation as a training process were interpreted as effective, generating a high degree of satisfaction.

Purpose

To analyze the long-term trends by age and sex of mortality from diabetes mellitus (DM) in Chile, during the years 1990–2020.

Material and method

The standardized mortality rate for DM was analyzed, according to age and sex, through the elaboration of a retrospective cohort study. The age-adjusted mortality rate trend was examined, using joinpoint regression analysis to estimate the annual percentage change and to assess its statistical significance.

Results

A total of 97,939 deaths were registered between 1990–2020 (49,273 men and 48,666 women) in Chile. The crude mortality rate was slightly higher in men and 60% of deaths occur in people over 80 years of age. The trend analysis showed a statistically significant increase in annual percentage change of 3.16% until 2002 and then a constant decrease of -1.25% per year. In the analysis by sex, in men there was an increase in annual percentage change of 0.99% per year, while in women there was a decrease of -0.92% per year.

Conclusions

Mortality from DM has sustained a constant decrease since 2002. However, when the data is analyzed by sex, men have a higher mortality rate with and upwards trend throughout the years studied. It is important to carry out a study of other variables that might explain these results, in order to reach a conclusion that could impact on the outcomes of patients with DM.

Pericardial effusions can be identified by basic imaging methods, such as chest X-rays. We report the case of a 34-year-old male who presented with dyspnea and chest pain. On chest X-rays a classic sign described as the “Oreo® cookie” sign was identified, which is highly suggestive of pericardial effusion and extremely useful in medical centers where ultrasound or tomography is not available. We present a brief review of the anatomical explanation of this sign and its confirmatory visualization in tomography.

Introduction

The use of protective mechanical ventilation and prone position was recommended for the management of moderate to severe acute respiratory distress syndrome (ARDS) due to COVID-19, as a result of its reported utility on oxygenation and mortality. Our objective is to describe gasometric and mechanical behavior in subjects with ARDS due to COVID-19 managed with protective mechanical ventilation and prone position in a high complexity hospital.

Method

Observational study. Subjects ≥18 years of age with ARDS due to COVID-19 were included. Protective mechanical ventilation was started from the first connection to invasive ventilation, while the prone position started with PaO₂/FIO₂  150. Follow-up was performed during and after the prone position. A descriptive analysis of baseline characteristics and comparison of means between groups was performed using the Dunn and Friedman test. Statistical significance corresponds to p  0.05 in all analyses.

Results

74 subjects were studied, 58% correspond to men with a mean age of 60 years. There is evidence of a significant increase in arterial oxygenation assessed by PaO₂ (76 to 98 mmHg, p  0.05) and PaO₂/FIO₂ (100 to 161, p  0.05) during the first hour of treatment, with stability of values beyond 48 hours after supination. Pulmonary mechanics values remain constant within the established protection range (p = 0,18).

Conclusion

The strategy of protective mechanical ventilation and prone position for 48 or more hours, in subjects with moderate to severe ARDS due to COVID-19, improves and maintains arterial oxygenation up to 48 hours after supination.