Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest

xlomafota13 shared this article with you from Inoreader Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest Via Experimental and therapeutic medicine Exp Ther Med. 2022 Mar;23(3):196. doi: 10.3892/etm.2022.11119. Epub 2022 Jan 5. ABSTRACT The extended lateral side approach is a common technique in the surgical treatment of calcaneal fractures, with thalamic collapse offering a good exposure of the fractured site; however, it can be burdened with complications due to soft tissue trauma. The present study aimed to compare patients treated with minimally invasive osteosynthesis through a minimum lateral approach and internal fixation with patients that were treated using internal fixation with an extended lateral side approach in cases of intra-articular calcaneal fractures with thalamic fracture. Patients were evaluated preoperatively and postoperatively by performing clinical and imagistic examinations, with radiography scans of the anterior-posterior calcaneal profile and computer tomography. Furthermore, preoperative and postoperative analyses of the Böhler angle on the radiologic al profile, complications and duration of the hospital admission for both groups were performed. There were 36 patients (39 calcaneal fractures) in group 1 and 24 patients (29 calcaneal fractures) in group 2. The results demonstrated no statistically significant differences in the preoperative (P=0.72) and postoperative (P=0.20) Böhler angle values. The postoperative Böhler angle average values were 26.9 in group 1 and 29.3 in group 2. A total of 11 patients were treated with Kirschner wires inserted in the calcaneus, and in 2/ll cases, one of the brooches registered a migration movement. There were no cases of material migration in the fractures that were stabilized by inserting Kirschner brooches up to the astragalus and cuboid bones. Taken together, the results of the present study demonstrated no significant differences in the Böhler angle values between the minimally invasive and open reduction techniques. However, the antibiotic therapy period, as well as the infection rate were lower in patients that were treated using the minimally invasive technique, suggesting that this technique was superior with respect to lower complication rates and improved functional results. PMID:35126699 | PMC:PMC8794544 | DOI:10.3892/etm.2022.11119 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

From chronic pruritus to neuroendocrine tumor: A case report

xlomafota13 shared this article with you from Inoreader From chronic pruritus to neuroendocrine tumor: A case report Via Experimental and therapeutic medicine Exp Ther Med. 2022 Mar;23(3):189. doi: 10.3892/etm.2022.11112. Epub 2022 Jan 4. ABSTRACT Chronic pruritus is a major and distressing symptom of many diseases of dermatological, neurological, psychogenic or systemic origin. This chronic itch could be a presenting sign of malignancy; therefore, paraneoplastic pruritus has also been associated with neuroendocrine tumors (NETs). This article focuses on a patient presenting with chronic pruritus for the past 12 months and who received numerous treatment schemes with very poor clinical improvement, that presented in the hospital for worsening of the chronic pruritus associated with skin rash and significant weight loss (approximately 6 kg over a 2-month period). The laboratory tests showed iron deficiency anemia, eosinophilia and negative tumor markers. In order to investigate the hypoanabolic and anemic syndromes, upper gastrointestinal endoscopy and colonoscopy, which showed no lesions or tumors, were employed. Skin biopsy was performed and antihistaminic and local steroid treatment was initiated. The patient's status worsened within a week and the patient was started on systemic steroid treatment with poor results. Computer tomography was performed to identify any tumor(s) located either in the pelvis or abdomen. A lesion was found in the terminal ileum, identified as a hypervascularized associating bulky lymphadenopathy. The patient was transferred to the surgical ward where right hemicolectomy with manual ileotransverse anastomosis L-L was performed. The histopathological result confirmed NET G2. The patient clinically improved, the skin lesions resolved and the itchiness disappeared. The general status improved significantly. NET G2 diagnosing was possible due to the atypic paraneoplastic sign: chronic pruritus. This case study highlights the association between itch and malignancy and presents an atypical way of NET presentation when all tumor markers remain neg ative. PMID:35126692 | PMC:PMC8794552 | DOI:10.3892/etm.2022.11112 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Delineating the risk factors of venous congestion: An analysis of 455 deep inferior epigastric perforator flaps with radiographic correlation

xlomafota13 shared this article with you from Inoreader Delineating the risk factors of venous congestion: An analysis of 455 deep inferior epigastric perforator flaps with radiographic correlation Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 16:S1748-6815(22)00017-1. doi: 10.1016/j.bjps.2022.01.003. Online ahead of print. ABSTRACT BACKGROUND: Venous congestion occurs in 2-15% of DIEP flaps for breast reconstruction. We previously showed that thicker suprascarpal fat pads are associated with increased SIEV caliber and may, by extension, indicate a dominant superficial venous system. In this study, we aim to provide clinical correlation and to determine the risk factors of venous congestion in order to identify high-risk patients who may benefit from prophylactic SIEV dissection. METHODS: An IRB-approved retrospective study was performed in patients who underwent DIEP flap reconstruction from August 2011 to August 2020. Radiographic measurements of suprascarpal fat pad thickness and SIEV diameter were collected per hemi-abdomen from preoperative imaging. The statistical analysis explored whether certain variables were associated with venous congestion. RESULTS: A total of 258 patients underwent 455 DIEP flaps. Suprascarpal fat pad thickness was positively correlated with SIEV diameter (r = 0.51, p<0.001), each with a mean caliber of 19.8 mm and 2.5 mm, respectively. Seven flaps (1.5%) developed venous congestion, with five requiring SIEV salvage and secondary venous anastomosis. Congested flaps had significantly thinner suprascarpal fat pads (12.3 vs. 20.0 mm, p = 0.043). All six congested flaps with imaging had suprascarpal thickness less than 18 mm, compared to 182 out of 335 non-congested flaps with imaging (p = 0.035). CONCLUSIONS: The risk of venous congestion following DIEP flap reconstruction is significantly increased with thinner suprascarpal fat pads, suggesting that the mechanism of venous congestion may not be limited to superficial venous dominance. We recommend prophylactic SIEV dissection in all patients with suprascarpal fat pad thickness less than 18 mm. PMID:35125307 | DOI:10.1016/j.bjps.2022.01.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ética médica en la práctica clínica

xlomafota13 shared this article with you from Inoreader Ética médica en la práctica clínica Via Otorrinolaringología y cirugía de cabeza y cuello Resumen La actividad médica se puede ver en dos contextos diferentes, tanto en la práctica clínica como en la investigación científica. El concepto de práctica clínica es todo acto realizado sobre un paciente con el objetivo de diagnosticar o tratar enfermedades. Por otro lado, la investigación clínica cuestiona diferentes aspectos relacionados con la salud humana. Este estudio busca inicialmente esclarecer los aspectos y componentes que orientan la relación y comunicación médico-paciente, definiendo los valores éticos de esta práctica, donde el profesional médico modela su carácter, mediante una relación entre los principios abordados en el ámbito de la ética de los profesionales de la salud. La demostración de una adecuada y sana relación de los profesionales médicos con sus pacientes es necesaria y fundamental a través del respeto y principalmente a través del principio de autonomía, ya que todo ser humano debe ser reconocido como fin y dueño de sí mismo, donde las actividades médicas comprenden procesos que involucran vida, salud e integridad física. Así, el presente trabajo abordará los diversos aspectos de la ética médica, en relación con el contexto de la práctica clínica del médico. Abstract The medical activity can be seen in different contexts, both in clinical practice and in scientific research. The concept of clinical practice is every act performed on a patient with the objective of diagnosing or treating illnesses. On the other hand, clinical research questions different aspects related to human health. This study initially seeks to clarify the aspects and components that guide the doctor-patient relationship and communication, defining the ethical values of this practice, from which the medical professional models its character, through a relationship between the principles addressed in the scope of their ethics. health professionals. The demonstration of an adequate and healthy relationship between medical professionals and their patients is necessary and fundamental through respect and mainly through the principle of autonomy, since every human being must be recognized as an end and duen of symbolism, hence medical activities include processes that involve life, health and physical integrity. Thus, this work will address the various aspects of medical ethics, in relation to the context of the clinical practice of the doctor. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adenitis cervical con anaerobios sin causa aparente en lactante

xlomafota13 shared this article with you from Inoreader Adenitis cervical con anaerobios sin causa aparente en lactante Via Otorrinolaringología y cirugía de cabeza y cuello Resumen Las adenopatías cervicales benignas en lactantes son relativamente frecuentes, se definen como el aumento de volumen ganglionar de más de 1 cm, sin síntomas sistémicos y cuando están presentes, el término correcto es adenitis. Para su estudio, las adenitis se dividen en: locales, sistémicas, unilaterales, bilaterales, agudas, crónicas, y por edad, con diferentes etiologías. Se presenta el caso clínico de un lactante de 11 meses de edad con diagnóstico de adenitis cervical abscedada unilateral aguda, con cuadro de 72 h de evolución, con crecimiento constante a nivel cervical derecho, compromiso del estado general, fiebre y anorexia, por lo que se inician antibióticos de primera línea para los agentes bacterianos más frecuentes (Staphylococcus aureus y Streptococcus pyogenes), con evolución tórpida a las 48 h, por lo que se solicita ultrasonido cervical, ya que la familia no contaba con recursos para solicitar cultivo o tomografía, reportando el ultrason ido ganglio cervical de 3,5 cm de diámetro abscedado, por lo que se agrega cobertura para anaerobios, con respuesta muy favorable a las 24 h. Queda la duda del origen de los anaerobios en la paciente, sin antecedentes de importancia y en grupo etario diferente al afectado por esos gérmenes. Consideramos este caso interesante por su comportamiento atípico, para el enriquecimiento del ejercicio de la otorrinolaringología, recalcando el invaluable apoyo de la clínica y solo con un ultrasonido, ya que no siempre se tendrán todos los recursos disponibles, pero siguiendo las pautas de lo reportado en la literatura, se tuvo una resolución exitosa. Abstract Benign cervical lymphadenopathies in infants are relatively frequent, they are defined as an increase in lymph node volume of more than 1 cm, without systemic symptoms, and when they are present, the correct term is adenitis. For its study, adenitis is divided into: local, systemic, unilateral, bilateral, acute, chronic, and by age, with different etiologies. An 11-month-old infant with a diagnosis of acute unilateral abscessed cervical adenitis, with a 72 h evolution, with constant growth at the right cervical level, fever and anorexia, for which first-line antibiotics were started to the most frequent bacterial agents (Staphylococcus aureus and Streptococcus pyogenes), with torpid evolution at 48 h, for which only cervical ultrasound is requested, since the family did not have the resources to request culture or tomography, reporting the cervical ganglion ultrasound of 3.5 cm of abscessed diameter, so coverage for anaerobes is added, with a very favorable response at 24 hrs. There remains the doubt of the origin of the anaerobes in the patient, without important antecedents and in an age group different from that affected by these germs. We consider this case interesting due to its atypical behavior, for the enrichment of the otolaryngology exercise, emphasizing the invaluable support of the clinic, and only with an ultrasound, since other clinical tools were not available, but following the guidelines of what is reported in literature, there was a successful resolution. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total

xlomafota13 shared this article with you from Inoreader Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total Via Otorrinolaringología y cirugía de cabeza y cuello Resumen Introducción: La sutura mecánica es una opción para el cierre de la faringorrafia en laringectomía total por cáncer de laringe. Objetivo: Comparar el uso de sutura mecánica lineal con sutura manual de la faringe durante la laringectomía total por cáncer de laringe. Material y Método: Se realizó un estudio de tipo experimental prospectivo. Se compararon dos grupos pacientes: Los pacientes con sutura mecánica desde 2018 a marzo de 2020 y los pacientes con sutura manual previa a enero de 2018 en el Servicio de Otorrinolaringología del Hospital Barros Luco. Se analizaron fístula faringo-cutánea posoperatoria (FFC), tiempo operatorio, estadía hospitalaria y costo. Resultados: El estudio incluyó a 14 pacientes, cada grupo con n = 7. El grupo con sutura mecánica presento 0% de FFC y el grupo sutura manual 28%. El grupo con sutura mecánica reinicio alimentación a los 7 días y el grupo con sutura manual en promedio a los 11,5 (7-23) días. (p = 0,0023). E l tiempo promedio de cirugía para el grupo experimental es de 288 ± 37,4 minutos y con sutura manual 311 ± 32,4 minutos. (p = 0,0176). El promedio de hospitalización para el grupo experimental fue de 11 ± 2,6 días (9 a 16), y para el grupo control fue de 21 ± 14 días (10 a 49) (p < 0,0001). Conclusión: La sutura mecánica es un procedimiento fácil de usar y seguro. Existiría un beneficio en el uso de sutura mecánica para el cierre faríngeo al compararlo con la sutura manual al disminuir el número de FFC, el tiempo operatorio y los días de hospitalización. Abstract Introduction: Mechanical suture is an option for the closure of the pharyngorrhaphy in total laryngectomy due to laryngeal cancer. Aim: To compare the use of linear mechanical suture with manual pharyngeal suture during total laryngectomy for laryngeal cancer. Material and Method: A prospective experimental study was carried out. Two patient groups were compared: patients with mechanical suture fr om 2018 to March 2020 and patients with manual suture prior to January 2018 at the otorhinolaryngology service of the Barros Luco Hospital. Postoperative pharyngocutaneous fistula (FFC), operative time, hospital stay and cost were analyzed. Results: The study included 14 patients, each group with n = 7. The group with mechanical suture presented 0% of FFC and the group with manual suture 28%. The group with mechanical suture restarted feeding at 7 days and the group with manual suture on average at 11.5 (7-23) days (p = 0.0023). The average surgery time for the experimental group was 288 ± 37.4 minutes, while for the group with manual suture was 311 ± 32.4 minutes (p = 0.0176). The mean hospitalization for the experimental group was 11 ± 2.6 days (9 to 16), and for the control group it was 21 ± 14 days (10 to 49) (p < 0.0001). Conclusion: The mechanical suture is an easy to use and safe procedure. There would be a benefit in the use of mechanical suture for pharyngeal closu re when buying it with manual suture by reducing the number of FFCs, operative time and days of hospitalization. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.