Cirugia y cirujanos最新文献

In the 1980s in Mexico, that of the «moral renewal», there was the opening to the market and the manifestation of human immunodeficiency virus (HIV) and AIDS. In this writing, the historical and therapeutic conditions are related to alleviate the syndrome until the arrival of the first antiretroviral. It is a reconstruction of the events, of which the medical-social, main clinical manifestations and of course the pharmacological therapy, until de the development zidovudina or azidotimidina of AZT, the first antiretroviral to be approved. Nevertheless, in the Mexican context, this event wasn't decisive to significantly change the morbility and the mortality.

Objective: The aim of this study was to evaluate the experience of using endoscopic submucosal dissection (ESD), a technique considered as first-line of treatment, for the management of early neoplastic lesions (ENL), and subepithelial lesions (SEL) < 4 cms in size, in a tertiary-care, high-volume medical center in Mexico.

Method: Patients > 18 years-old, candidates to ESD with ENL and SMT, between January 2008 and October 2022 were included.

Results: ESD was performed in 246 patients (137 ENL and 109 SMT), 52.2% gastric, 23.1% colonic, 19.5% esophageal and 5.2% in duodenum. Benign/premalignant were 74.4%, and 25.6% malignant, being the SMT the most frequent (44.3%) and gastrointestinal stromal tumor. En-bloc resection, R0, and curative resection rates were 97.2%, 94.5%, and 85.8%, respectively. The most common adverse event was transprocedural bleeding (18.3%) followed by perforation (6.9%), both endoscopically treated without mortality. Recurrence was presented in 9.44% at 177 months of follow-up.

Conclusions: ESD is a safe and effective endoscopic surgical option of treatment for ENL and SMT in Mexican population when performed in experienced centers.

Objective: To compare the costs of care and the opportunity of care for the management of grade I-II ankle sprain in two Family Medicine Units, one with rehabilitation service (FMU 13) and one without rehabilitation service (FMU 41).

Method: Observational analytical study, records with diagnosis of grade I-II ankle sprain attended at the FMU were included January-November 2021. Consultations were recorded in the emergency department, family medicine, rehabilitation, cabinet studies and time to grant the appointment in the rehabilitation service (opportunity of care), the Mann-Whitney U test was used to compare costs of care and timeliness of care.

Results: In FMU 41, care costs were higher compared to FMU 13 ($13,990 vs $8,063); however, this difference was not significant, as was the cost of care in family medicine, rehabilitation, and opportunity of care.

Conclusions: The costs of care and the opportunity of care were similar in both models of care (FMU 13-FMU 41) of grade I-II ankle sprain.

Objective: The objective of this study was to investigate the clinical effect of overlap anastomosis and functional end-to-end anastomosis (FEEA) in laparoscopic radical resection of colorectal cancer (CRC).

Methods: The clinical data of 180 patients who underwent laparoscopic radical resection of CRC and side-to-side anastomosis were retrospectively collected; the patients were divided into the Overlap group and FEEA group, according to the anastomosis method that was used to treat them.

Results: The Overlap group had a shorter operation time, anastomosis time, post-operative hospital stay, post-operative feeding time, and post-operative exhaust time than the FEEA group (p < 0.05). The total incidence of post-operative complications was 14.4% (13/90) in the FEEA group and 0.7% (6/90) in the Overlap group, and there was no significant difference between the two groups (p > 0.05).

Conclusions: Overlapping anastomosis can shorten the operation time and accelerate the recovery of intestinal function without increasing the incidence of post-operative complications, and it will not affect the quality of life and survival of patients in the short term after surgery.

Pneumopericardium is an unusual condition defined by the presence of gas into the pericardial sac. Gastric perforation into pericardium is a complication of gastric ulcer with high mortality. In this clinical case, we describe the condition of a male with a silent gastric ulcer, which penetrated into the pericardium, developing pneumopericardium and purulent pericarditis as a complication.

Introduction: Littoral cell angioma (LCA) is a new subtype of vascular tumor, which has been reported infrequently worldwide. It is associated with visceral malignancies and other immunologic conditions.

Clinical case: We present a case of a 70-year-old Caucasian male with a 6-year history of myelodysplastic syndrome, which was investigated for splenomegaly and pancytopenia. Radiological and histopathological examinations revealed an LCA and an open splenectomy were performed. The patient had an uneventful post-operative recovery.

Conclusion: LCA is a rare tumor, with atypical presentation often associated with other malignancies or immunologic conditions. Diagnosis is challenging, and so far, splenectomy is the gold standard treatment.

Massive bleeding due to rupture of hypogastric artery pseudoaneurysm is an exceptional complication of colorectal anastomotic leakage. A 41-year-old woman with history of rectal cancer surgery, who debuted with massive rectorrhagia and hypovolemic shock due to rupture of a hypogastric artery pseudoaneurysm as a late complication of a colorectal anastomosis leak. The ruptured hypogastric artery pseudoaneurysm should be taken into account in the differential diagnosis of patients with massive rectorrhagia and history of colorectal anastomosis leak. Endovascular embolization is considered the first-line treatment.

Objective: This study aimed to compare the effects of bladder diverticula smaller than 30 (SD) mm and larger than 30 mm (LD) on bladder functions and urodynamics.

Materials and methods: Our retrospective analysis involved a cohort of 40 pediatric patients diagnosed with primary bladder diverticula.

Results: The predicted mean bladder capacity (MBC) was 197.7 ± 95.8 mL, whereas the observed MBC was lower at an average of 170.1 ± 79.6 mL. This indicates that the observed MBC was 88.2 ± 12.9% of the predicted value (percentage). The mean diverticula diameter recorded was 33 ± 19.5 mm, and the diverticula to MBC ratio were calculated to be 0.25 ± 0.18. The distribution of urinary tract infections (UTIs) differed significantly between the groups (p < 0.001). Upper UT dilatation was significantly more common in the LD group (60%, n = 12) than in the SD group (15%, n = 3) (p = 0.003). The mean detrusor pressure (P[detrusor]) was significantly higher in the LD group (137.2 ± 24.1 cm H₂O) than in the SD group (63.9 ± 5.8 cm H₂O) (p = 0.001). In addition, the mean peak flow rate (Q_max) was significantly higher in the SD group (20.7 ± 7.9 mL/s) compared to the LD group (12.7 ± 3.8 mL/s) (p < 0.001).

Conclusion: Bladder diverticula size is a significant factor in the clinical presentation and management of primary bladder diverticula in pediatric patients.

Patients with chronic liver disease of any etiology who become infected with SARS-CoV-2 have been found to have a higher risk of mortality compared to those patients who do not have chronic liver disease. A literature review was conducted in the relationship between COVID 19 and preexistence of liver disease. The proportion of COVID-19 patients with abnormal liver function on admission ranged from 40 % to 75 % and the proportion with liver injury was close to 30%. Current studies show an important association between preexisting liver disease and COVID-19. The presence of cirrhosis is now an independent predictor of severity for COVID-19 and prolonged hospitalization in this group of patients. Patients with cirrhosis have a higher mortality rate, and this rate rises with increasing severity.