Cirugia y cirujanos最新文献

Objective: Analyze the approach of the multilayer flow modulator (MFM) based on the results obtained in patients treated with Stena MFM^® (S-MFM).

Methods: It was evaluated 6-month follow-up outcomes of 12 patients (nine men and three females; mean age 60 years, range 34-79 years) underwent aneurysm repair with the S-MFM between July 2022 and December 2022. All patients undergoing S-MFM were patients at high risk of mortality and/or morbidity for open surgical repair and endovascular aneurysm repair, including thoracic Endovascular Aortic Repair (TEVAR) or fenestrated endovascular aortic repair (FEVAR).

Results: The control angiograms confirmed successful patency in the lumen of the main aorta and the branches in all cases. Complete aneurysm thrombosis was detected in all patients on computed tomography angiography at 6-month follow-up. The technical success was 100%, and no case required immediate intervention. Significant complications, such as ruptures, stent migrations, retractions, thrombosis, fractures were not observed.

Conclusions: The present data show the MFM approach may be an attractive alternative for complex aortic aneurysms. While it shrinks the aneurysm sac and protects the side branch blood flow, it reduces mortality and morbidity risks.

Objective: Diabetic nephropathy (DN) is a significant complication of diabetes. Despite strict management of fasting plasma glucose (FPG), DN may progress to end-stage renal disease. HbA1c, the best biomarker for glycemic management, may differ in similar FPG. Hemoglobin glycation index (HGI) = HbA1c as determined minus HbA1c as predicted. The triglyceride-glucose index (TGI) is found to detect insulin resistance and correlates with DN. The aim of this study is to see the association of TGI and HGI with diabetic nephropathy in type 2 diabetes patients.

Method: 234 patients with type 2 diabetes were analyzed retrospectively.

Results: 87 (37.2%) of 234 patients were male, and the mean age was 57.2 ± 11.1 years. 76 of the patients had DN. HGI and TGI were significantly higher in the DN group (2.59 ± 1.7 vs. 1.18 ± 0.34; p = 0.00 and 9.9 ± 0.7 vs. 9.7 ± 0.7; p = 0.024). In logistic regression analysis, microalbuminuria was associated with TGI (OR = 3.35, 95% CI, 1.778- 6.32, p = 0.01) and HGI (OR = 2.579, 95% CI, 1.89-3.516, p = 0.00).

Conclusions: In conclusion, TGI and HGI were independently associated with diabetic nephropathy. These markers may be useful in DN, especially in anemic individuals, since anemia might affect HbA1c levels.

Pilonidal disease usually arises in the sacrococcygeal area in young men. We present a case of a 39-year-old male with an initial diagnosis of perianal fistula. Despite clinical examination and pelvic magnetic resonance image, only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease. Perianal pilonidal sinus are very rare in the literature. It is often confused with other perianal diseases such as anal fistula. Thus, perianal pilonidal disease should be considered in the differential diagnosis of perianal fistula.

Objective: The main goal in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is to achieve a pathologic complete response (pCR). Our study examines whether neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), NLR/PLR, systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation-value (PIV) indices can be used to determine pCR and prognosis.

Methods: The study included 228 patients who received NAC for breast cancer between 2010 and 2021.

Results: Fifty-nine (25.9%) patients had pCR to NAC. In univariate analysis, a significant difference was found between clinical node status, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), breast cancer molecular subtypes, and pCR (p < 0.05). However, in multivariate analysis, only breast cancer molecular subtypes and HER2 status were significantly associated with pCR (p < 0.05).

Conclusions: Our study did not find a significant relationship between NLR, PLR, MLR, NLR/PLR, SII, SIRI, and PIV indices and pCR, disease-free survival, and overall survival in breast cancer patients who received NAC.

Objective: Put into practice the MACTOR (Method, Actors, Objectives, Strength Results) method to identify and analyze convergence of objectives in actors with influence maps of strategic health power.

Method: It is an analytical study, sampled for convenience in time and for accessibility to experts in three high specialty hospitals with deductive reasoning, of explanatory scope in correlation of strategic objectives convergent to health processes through MACTOR.

Results: Understand the importance, analyze and understand the prospective in the decision making of the actors that impact this research with global leaders from the World Health Organization, the Pan American Health Organization, the CONACEM committee and the president of the Council of Health in its strategic deployment to hospital medical care.

Conclusions: The prospective analysis of actors makes it easier to evaluate health leaders according to their influence due to the convergence or not of institutional objectives. MACTOR is relevant in order to visualize the contribution in favor or against the scope of effort with strategic alignment in institutions until reaching hospitals and continuing specific achievements for the benefit of medical care.

Objective: To describe the correlation between Hounsfield Units in opportunistic computed tomography (CT scan) and T-score measured by dual energy X-ray absorptiometry (DXA) in the Chilean population.

Method: Female patients over 50 years old with CT scan and DXA performed within 6 months. Hounsfield units (HU) were measured by circular regions-of-interest placed on axial slice image of the L1 vertebral body in the CT scan. T-score was obtained through DXA scan in L1-L4 vertebrae.

Results: 144 female patients were included with a mean age in years of 68.39 ± 8.75. A moderate correlation was found between T-score and HU (Pearson coefficient of 0.6, p < 0.001). The mean values of HU differ significantly between the groups of Osteoporosis (OP) (89.46 ± 20.20), Osteopenia (110.87 ± 30.74) and normal bone mineral density (154.53 ± 38.90) (p < 0.01). The area under curve for diagnostic capacity was 0.81 (95% CI 0.72-0.9). The HU thresholds for the diagnosis of OP were 101 (sensitivity 75%, specificity 75%).

Conclusion: Opportunistic CT scan is a useful tool in Chilean population to perform a screening for OP.

VACTERL association is a rare entity in newborns, with high mortality in the first year of life. We present a case of a female newborn, product of a twin pregnancy assisted by egg donation. During reanimation, absence of anal orifice and impossibility to pass the orogastric tube were evidenced, so she was admitted to the neonatal intensive care unit for study and treatment, where we found anal atresia, esophageal atresia type III, tetralogy of Fallot and duodenal atresia. There are no reports of this association in twin pregnancies by egg donation with an affected twin.

Objective: To evaluate the clinical, imaging and histopathological characteristics in benign breast lesions in men over a three-year period in a reference oncology center.

Methods: Descriptive retrospective cohort study carried out on male patients treated at the Unidad Médica de Alta Especialidad No. 4 Luis Castelazo Ayala between the years 2021 and 2023, who came for some alteration of the mammary gland, confirming a diagnosis of benignity by imaging and histopathology. Descriptive statistics were used for the analysis of clinical, imaging and histopathological findings.

Results: 20 male patients attended the breast oncology service; four patients were excluded for not meeting the established inclusion criteria, to obtain a population sample of 16 patients. The main benign histopathological finding was myofibroblastoma in 25% of patients. The main reason for consultation was the presence of a palpable nodule.

Conclusions: Breast pathology in men is little known due to its low prevalence. Currently, there are no established protocols on its diagnostic and therapeutic approach. It is important to consider the risk factors and the findings obtained in the clinic, by imaging and histopathology, to treat them well.