Cirugia y cirujanos最新文献

Background: Sudden Sensorineural Hearing Loss was described by Mc. Cabe in 1979 and, since then, many authors have tried to define, explain and correctly treat this disease. The National Institute on Deafness and Other Communication Disorders defines it as sudden sensorineural hearing loss of at least 30 dB in three contiguous audiometric frequencies in a period of 72 hours. Among the therapeutic strategies, corticosteroids have been shown to have the greatest benefit due to their anti-inflammatory and anti-cellular stress effects.

Objective: To determine the hearing results with combined steroid therapy in patients with sudden sensorineural hearing loss (SSHL), according to the Siegel recovery criteria scale.

Method: Study carried out in the otorhinolaryngology and head and neck surgery service of the Centro Médico Naval, Ciudad de México, where 150 patients diagnosed with SSHL and who received combined therapy with intratympanic dexamethasone and systemic prednisone were included.

Results: Therapeutic effectiveness was demonstrated by correlating therapeutic success in 82% of cases and therapeutic failure in 18% of cases, by correlating it with the Siegel recovery criteria scale. When evaluating the general average of the pure tone average levels at the beginning and 6 weeks after treatment, a statistically significant difference was obtained (p = 0.001). The average of the speech audiometry at the beginning and 6 weeks later had a statistically significant difference (p = 0.001).

Conclusions: Initial combined steroid treatment for SSHL has been shown to have beneficial results according to Siegel recovery criteria scale.

Objective: The objective of the study was to systemically evaluate the clinical efficacy of minimally invasive stereotactic puncture for intracranial hematoma evacuation in patients with cerebral hemorrhage.

Materials and methods: Relevant studies in PubMed, Web of Science, MEDLINE, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched. A meta-analysis was performed following the inclusion and exclusion criteria screening, data extraction, and literature quality evaluation.

Results: Fifteen studies involving 1312 patients were included with 673 participants in the experimental group and 639 in the control group. The results of the meta-analysis showed that, compared with traditional craniotomy or treatment, minimally invasive stereotactic puncture intracranial hematoma removal had a higher clinical total effective rate in patients with cerebral hemorrhage, an outcome that could significantly shorten the hospitalization time of patients with cerebral hemorrhage. The level of post-operative activities of daily living was significantly higher, the incidence of postoperative complications was lower, and the mortality rate was lower. However, there was no significant difference in the degree of post-operative neurological deficit.

Conclusion: Compared with traditional craniotomy or conservative treatment, minimally invasive stereotactic puncture intracranial hematoma removal has a higher clinical efficacy in the treatment of patients with cerebral hemorrhage, which can improve the post-operative daily life and abilities of patients.

Objective: Acidosis is the most dangerous complication in subarachnoid hemorrhage (SAH). This study aimed to investigate the effect of acidic cerebrospinal fluid on central canal structures after SAH.

Materials and methods: Twenty-eight hybrid rabbits were studied. Blood and cerebrospinal fluid pH values were recorded before/during/after the experimental procedures. The structures related to the central canals at the level of C5 of the cervical spinal cord were then examined histopathologically. The relationship between pH values of ependymal cells and degenerated epithelial cell densities was statistically analyzed.

Results: Mean blood pH values and degenerated ependymal cell density (n/mm²) were as follows: 7.351 ± 0.033/23 ± 7 in control, 7.322 ± 0.059/78 ± 13 in SHAM, and 7.261 ± 0.048/254 ± 62 in study animals. Gross examinations revealed swelling, edema, pia-arachnoid adhesions, ventral canal dilatation, arachnoiditis, central canal hemorrhage, occlusions, and dilatation in the spinal cord.

Conclusion: Cerebrospinal fluid acidosis-induced central channel pathologies should be considered an important complication of SAH following SAH.

Background: Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects.

Objective: To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention.

Method: An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student's t and χ², taking p ≤ 0.05 as significant.

Results: 94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826).

Conclusions: After this training, 80% of family medicine residents were able to detect DDH in a timely manner.

Background: Chronic venous disease is a frequent and prevalent pathology. Its surgical treatment has been shown to be cost-effective. Thermal endoablation performed as major outpatient surgery (MAS) is the technique of choice.

Objective: To know the satisfaction of patients after MAS and the quality of care provided.

Method: Observational, descriptive, cross-sectional study, carried out between January 2019 and March 2020. A survey was carried out on patients who underwent endovascular radiofrequency thermoablation in two hospitals in Spain, consisting of two questionnaires: one ad hoc and one another of satisfaction (SERCAL). Quality indices for MAS were measured.

Results: We analyzed 156 episodes. 145 interventions were carried out. We found 4 (2.8%) unscheduled admissions. 3 patients (2.1%) attended the emergency department. There was a 99.3% success rate. 100% of the patients had pre-surgical recommendations and informed consent. We obtained 48 surveys (response rate: 33.1%). All the patients gave a rating greater ≥ 8 in quality of care (x = 9.83) and would recommend this procedure to their relatives (x = 9.71).

Conclusions: Endovascular radiofrequency thermoablation performed in MAS has a high success rate and a very low rate of admission and visit to the emergency room. Patient satisfaction is high.

Background: Graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation.

Objective: To elucidate the role of Toll-like receptor 4 (TLR4), the major receptor for bacterial lipopolysaccharide, in the development of GVHD, we constructed a GVHD model in TLR4 knockout (TLR4^-/-) mice and monitored the cell chimerism.

Methods: In this study, we used polymerase chain reaction to identify whether TLR4 knockout (TLR4^-/-) mice were established. Before transplantation, we pretreated mice with irradiation so as to obtain an appropriate irradiation dose. Flow cytometry was applied to measure the chimerism status, the distributions of antigen-presenting cells (APCs), and T-cells in TLR4^+/+ and TLR4^-/- recipient mice.

Results: The general condition of TLR4^-/- recipients was better than that of TLR4^+/+ recipients, and the TLR4^-/- recipient mice showed less severe GVHD manifestations than the TLR4^+/+ recipient mice. Most of the APCs and T-cells in the host mouse spleen were derived from donor cells, and CD4⁺ T-cells, including memory T-cells, were in the majority in host mice.

Conclusion: In general, our data show that TLR4 deletion attenuated GVHD development, which suggests that TLR4 could be used as a novel target and therapeutic paradigm in GVHD therapies.

Objectives: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks.

Methods: Pre-operative, post-operative 1^st and 6^th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared.

Results: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1^st- and 6^th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively.

Conclusion: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

Objective: To present the treatment of choice and approach in pregnant and postpartum women with a diagnosis of gallstones in Mexico and to compare it with the recommendations of international guidelines.

Method: Observational, descriptive, and retrospective study based on information from the 2019 Dynamic Cubes database of pregnant women diagnosed with cholecystitis and/or cholelithiasis who had undergone cholecystectomy.

Results: During 2019, 937 patients with cholelithiasis and cholecystitis were registered, 516 (55%) pregnant and 421 (45%) in puerperium. 91.47% of cases were managed with medical treatment and 8.53% with cholecystectomy, with predominance in the open approach in 63.75% of cases. Mortality was nil in both groups.

Conclusions: Despite current international guidelines recommending early laparoscopic cholecystectomy in pregnant or puerperal women, in Mexico medical treatment, delayed cholecystectomy and its open approach are still privileged.