Cirugia Y Cirujanos最新文献

Objective: The increased survival rates of end-stage renal disease (ESRD) patients have impacted directly in the proportion of elderly patients requiring a reliable hemodialysis (HD) access; this group clearly demands an individualized approach. We aim to analyze maturation and patency rates of arteriovenous fistulas (AVF) in elderly patients.

Methods: This was retrospective review of a database of patients that underwent AVF creation in our institution. The maturation and patency rates were analyzed divided in groups based on age (equal and greater of 65 years, and patients under 65 years). Patency rates were compared using Kaplan-Meier analysis.

Results: Twenty patients ≥ 65 years old (mean 73, SD ± 5.4) were analyzed. The overall maturation rate in this group was 75% compared to 84.1% (p = 0.33) in the younger group (mean age 48 years, SD ± 17). The primary patency at 6 and 12 months for the ≥ 65 years group was 93% and 86%, respectively, compared with 85% and 81% for the younger group (p = 0.77).

Conclusion: Autogenous AVF remains the preferred and durable option for elderly patients. We found no difference in terms of maturation and patency rates compared to younger patients. Standardized protocols are needed to optimally select vascular accesses.

Introduction: Spigelian hernia is a rare entity, with higher improbability of acute appendicitis within it.

Case report: A 75-year-old female with a 30-year evolution hernia, abdominal pain, and fever of 1 week of onset, in whom was found an acute appendicitis within a Spigelian hernia.

Discussion: Spigelian hernia comprises 0.12-2% of all abdominal hernias. Presurgical diagnosis is stablished only in 50% of cases, with an hernial ring less than 2 cm and hidden localization. There isn't statistics of this complication because of the lack of case reports.

Introduction: The skeletal muscle area (SMA) and prognostic nutritional index (PNI) are both considered as predictive parameters for mortality and morbidity for various type of cancer. In this study, we aimed to identify the effects of pre-operative SMA and PNI values on post-operative mortality and morbidity in patients with periampullary region tumors (PRT).

Methods: Patients between 2010 and 2020 were retrospectively analyzed and divided into two groups according to SMA and PNI cutoff values. Univariate and multivariate analysis was performed to find potential risk factors.

Results: The mean age was 65.94 ± 11.242 and 54 (60.6%) of the patients were male. Hypertension was found a reducing factor for morbidity in both univariate and multivariate analysis (p = 0.039; p = 0.045). Chronic obstructive pulmonary disease and low PNI were found as factors affecting mortality in univariate analysis (p = 0.046; p = 0.014). However, only low PNI was found as an enhancing factor for mortality in multivariate analysis.

Conclusion: Although SMA is not a risk factor for post-operative morbidity and mortality, PNI can be considered as a risk factor for mortality in patients with PRT.

Objective: Provide a description of clinical characteristics, associated factors and outcome of tracheostomies performed in COVID-19 patients.

Method: Observational prospective study of 14 patients who underwent tracheostomy. 10 of them were diagnosed with COVID 19, confirmed with RT-PCR test of nasopharyngeal exudate and compatible tomographic findings.

Results: Of the 10 patients, five were discharged and five died. The average age of patients who died was 66.6 years; of those who were discharged, it was 60.4 years. Ventilatory parameters cut was taken as FiO₂ ≤ 40% and PEEP ≤ 8; of the patients discharged, four met both criteria. On the other hand, of the patients who died, neither met both. Of the latter, an average of APACHE II of 16.4 and SOFA 7.4 were documented, while in discharged patients an average of 12.6 and 4.6 were observed, respectively.

Conclusions: Tracheostomy performed in patients with specific criteria, such as low ventilatory parameters, age, or low score in severity scales, may have a better prognosis.

Background: To date, the main clinical interest in DPP4 is focused on its inhibition in diabetic patients to prolong the half-life of incretins. Epigenetic alterations resulting from DPP4 inhibition have been poorly explored.

Objective: The objective of this study was to determine, whether sitagliptin, a DPP4 inhibitor, has effects on the expression of KAT7 and SIRT1 (genes encoding a histone acetyltransferase and a histone deacetylase, respectively) in MCF7 breast cancer cells, which play an essential role in modulating the epigenetic landscape of chromatin.

Material and methods: MCF7 cells were incubated for 20 h with sitagliptin at concentrations of 0.5, 1.0 and 2.0 μM. Total RNA was isolated and the relative mRNA expression of KAT7 and SIRT1 was determined by RT-qPCR.

Results: There was downregulation in the relative expression of both genes; for KAT7, downregulation reached up to 0.49 (p = 0.027) and for SIRT1, it reached up to 0.55 (p = 0.037).

Conclusions: These results suggest that sitagliptin has effects on the histone epigenetic landscape. This topic deserves further study due to the current sample use of DPP4 inhibitors in diabetic patients.

Objective: To determine the incidence of salivary gland tumors in a population of a tertiary hospital in the State of Mexico, and to describe demographic variables.

Method: An observational, cross-sectional and retrospective study of salivary gland tumors reported in a tertiary hospital in the State of Mexico in the period 2008-2019 is presented.

Results: A prevalence of 0.049% was found. There was no difference between sex in the studied population. Benign salivary gland tumors were the most frequent (86.7%). The age range most affected was 51-60 years. The most frequently found tumor was the pleomorphic adenoma, followed by Warthin's tumor. There was 13.33% of sialolipomas, and one myoepithelioma. There were no cases of sublingual gland tumors or minor salivary glands.

Conclusion: Tumors of the major salivary glands are infrequent tumors; population cases from a central Mexican state and their demographic characteristics are presented to contribute to the information found in local and international literature.

Extrapulmonary tuberculosis is defined as that case of tuberculosis clinically diagnosed and confirmed by bacteriological studies that affects tissues and organs outside the lung parenchyma. Mexico is in third place among Latin American countries in terms of the incidence of pulmonary and extrapulmonary tuberculosis. Culture methods are still the gold standard for the diagnosis of extrapulmonary tuberculosis since they identify the species and susceptibility to drugs.