Medial incisional ventral hernia repair with Adhesix® autoadhesive mesh: descriptive study.

Nowadays, the gold standard for the surgical treatment of abdominal wall defects is the use of a mesh. There is an extensive variety of meshes, self-adhesive ones being among the most novel technologies. The literature on the self-adhesive mesh Adhesix® (Cousin Biotech Laboratory, 59117 Wervicq South, France) in medial incisional ventral hernia is scarce. We performed a retrospective descriptive study with prospective data collection from 125 patients who underwent prosthetic repair of medial incisional ventral hernia-M1-M5 classification according to European Hernia Society (EHS)-with self-adhesive mesh Adhesix® between 2013 and 2021. Follow-up was performed 1 month and yearly after the surgery. Postoperative complications and hernia recurrences were recorded. Epidemiological results were average BMI 30.5 kg/m2 (SD 5), highlighting that overweight (41.6%) and obesity type 1 (25.6%) were the most represented groups. 34 patients (27.2%) had already undergone a previous abdominal wall surgery. The epigastric-umbilical (M2-M3 EHS classification, 22.4%) and umbilical (M3 EHS classification, 20%) hernias were the predominant groups. The elective surgery technique was Rives or Rives-Stoppa with an associated supraaponeurotic mesh if the closure of the anterior aponeurosis of the rectus sheath was not surgically closed (13 patients). The most frequent postoperative complication was seroma (26.4%). The recurrence rate was 7.2%. The average follow-up length was 2.6 years (SD 1.6 years). According to the results of this study and the literature available, we consider that the self-adhesive mesh Adhesix® is an appropriate alternative mesh option for the repair of medial incisional ventral hernias.

Large changes in Pluto's atmosphere as revealed by recent stellar occultations.

Pluto's tenuous nitrogen atmosphere was first detected by the imprint left on the light curve of a star that was occulted by the planet in 1985 (ref. 1), and studied more extensively during a second occultation event in 1988 (refs 2-6). These events are, however, quite rare and Pluto's atmosphere remains poorly understood, as in particular the planet has not yet been visited by a spacecraft. Here we report data from the first occultations by Pluto since 1988. We find that, during the intervening 14 years, there seems to have been a doubling of the atmospheric pressure, a probable seasonal effect on Pluto.

Servicio de dispensación: interacción entre darunavir y quetiapina / Dispensing service: interaction between darunavir and quetiapine

Paciente varón de 52 años, con síndrome metabólico, virus de inmunodeficiencia humana (VIH), insomnio, trastorno de ansiedad generalizada, esquizofrenia y con medicación analgésica, que viene sufriendo numerosos episodios nocturnos de insomnio e intranquilidad. Tuvo que ser socorrido por el servicio de urgencias al presentar un estado de gran confusión, agitación y una profunda y marcada taquicardia. La revisión de la medicación nos permite asociar estos eventos adversos con un exceso de dosis de quetiapina producida por la interacción con darunavir. La intervención consiste en informar al médico de la sospecha de la influencia de la interacción de darunavir con quetiapina y en proponer la sustitución del antipsicótico por otro que utilice una vía metabólica diferente. Se espera que darunavir aumente las concentraciones plasmáticas de los antipsicóticos como quetiapina (inhibición de CYP3A). La administración concomitante de darunavir y quetiapina puede ser potencialmente grave dado que puede aumentar la toxicidad asociada a quetiapina. El psiquiatra sustituye quetiapina por clotiapina. A partir de este cambio en la medicación el paciente no vuelve a experimentar ninguno de los problemas que le aquejaban además de que ha recobrado el sueño. (AU)

Angiosarcoma in the small intestine. Apropos of a particular case.

Presentation of a case of small intestine primary angiosarcoma in a 70-year-old male. There is question of an extremely rare tumor in the gastrointestinal tract. Its symptomatology is similar to that of other tumors in the small intestine. An immunohistochemical study is usually essential for its anatomopathological diagnosis. The diagnosis is generally arrived at in its advanced stages, and that makes for a bad prognosis. The bibliography has been revised from this case on.

Pancreatic cancer. Management.

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.

Índice de sustitución en patología herniaria: estudio comparativo / Hernia substitution index: a comparative study

La monitorización y evaluación mediante el índice de sustitución (IS) de la cirugía herniaria debería formar parte de la gestión clínica de las Unidades de Cirugía Mayor Ambulatoria (CMA) en un Servicio de Cirugía General y Digestivo (CGD). En este estudio se evalúa la tendencia evolutiva del Índice de Sustitución (IS) en el proceso hernial en el Servicio de CGD del Hospital Universitario Santa Cristina (HUSC), en comparación con los Indicadores Clave nacionales y autonómicos. Material y métodos: Diseño: estudio descriptivo observacional y comparativo de indicadores del Servicio de CGD del HUSC, con respecto a indicadores de la media de hospitales nacionales y de la Comunidad de Madrid. Análisis estadísticos: todas las variables comparadas son proporciones, por lo que en el análisis estadístico se ha utilizado el método del Chi cuadrado (Chi 2) para comparación de proporciones de muestras independientes. La significación estadística se ha establecido para contraste a dos colas (alpha = 0,05; Beta = 0,2). Resultados: se analizan 5.506 procedimientos de hernias inguinales (hernias inguinales simples, bilaterales y recidivadas) intervenidas en el Servicio de Cirugía General del HUSC en los últimos 9 años (2006-2014). El IS medio fue del 72%. Específicamente, la hernia inguinal unilateral simple alcanzó un IS del 82%. Respecto al indicador clave ‘cirugía ambulatoria de la hernia`, en el HUSC se obtienen resultados superiores a indicadores nacionales (p < 0,05) y de la Comunidad de Madrid. Conclusiones: La CMA en el HUSC está más desarrollada que en promedio del SNS en relación al IS la patología herniaria, situándose como un referente nacional en este capo de la CMA. Existen oportunidades de mejora en el cambio de la modalidad anestésica, incrementando el uso de técnicas anestésicas que permitan una recuperación más rápida, como la anestesia local asociada a sedación (AU)

Introduction: To monitor and to evaluate the Hernia Substitution Index (SI) should be part the clinical management of the Major Ambulatory Surgery (MAS) Units in a General and Digestive Surgery Service. In this study the temporal trend of the SI in hernia process at the General Surgery Service of Santa Cristina University Hospital (SCUH) is evaluated compared with the national and regional key indicators. Material and methods: Design: Observational, descriptive and comparative study of SCUH indicators with respect to Key Indicators of the average of the national and region of Madrid hospitals. Statistical analysis: All variables compared are proportions; consequently, the statistical analysis was based on the chi-square method (Chi 2) to compare proportions of independent samples. Statistical significance was established for two-tailed contrast (alpha 0 0,05; Beta = 0,2). Results: The 5.506 inguinal hernia procedures (simple unilateral, bilateral and recurrent inguinal hernia ) performed by the General Surgery Service of SCUH during the last nine years (2006-2014) were analyzed. The average SI was 72%. Specifically simple unilateral inguinal hernia IS reached 82%. Regarding the Key Indicator `outpatient hernia surgery` the General Surgery Service of SCUH indicators are above those of national (p < 0,005) and the Madrid region. Conclusions: The MAS at General Surgery Service of the SCUH is more developed than the average of the national hospitals regarding the SI of hernia pathology, fact that position the General Surgery Service of SCUH as a national reference in this MAS field. There are opportunities for improvement in the change of anesthetic modality, increasing the use of techniques that allow earlier anesthetic recovery as local anesthesia associated with sedation (AU)

Funcionalidad manual en niños y adolescentes con discapacidad neuro-músculo-esquelética: resultados con pauta Bilan 400 points modificada / Hand functionality in children and adolescents with neuromusculoskeletal disabilities: results using modified Bilan 400 points scale

Cerebral palsy (CP) and other diseases cause different levels of dysfunction in the ability to grasp or grip with the hands. Modified and validated Bilan 400 points scale (PBM-400) helps to assess these functions. Objective: To determine the characteristics of hand function in children and young people with neuromotor disabilities according to gender, age, diagnosis and level using functional PBM-400. Patients and Methods: Descriptive and cross-sectional study on 138, 7 to 17 year-old patients with CP (diplegia, hemiparesis), obstetric brachial palsy (OBP) and others; with mild or moderate functional impairment, receiving treatment at Instituto Teletón in Santiago, Chile. Nine trained occupational therapists apply PBM-400 in standardized conditions, assessing hand mobility, grasp and/or movement, functional activities and grip strength with dynamometer, vigorimeter and pinch gauge. Result: 62.5 percent of diplegia patients and 100 percent of the patients with polyneuropathy, showed right laterality. According to functional impairment, right laterality prevails. Grip strength showed the lowest performance in all diagnoses, whereas in cases with prevalence of right-hand laterality it was functional activities. Significant differences in hand functionality were recorded depending on diagnosis and functional impairment, regardless of laterality. Age and gender do not affected hand functionality in the overall of children with various diagnoses. Conclusions: The modified Bilan 400 points scale helps to distinguish hand function depending on laterality, diagnose and functional impairment, becoming a generic scale for therapeutic decision making.

Introducción: La parálisis cerebral (PC) y otras patologías, implican diversos grados de disfunción en la ejecución de alcances y prensiones de las manos. La pauta Bilan 400 points modificada y validada (PBM-400), permite evaluar esas funciones. Objetivo: Determinar las características de la función manual en niños y jóvenes con discapacidad neuromotora según sexo, edad, diagnóstico y compromiso funcional, mediante PBM-400. Pacientes y Método: Estudio descriptivo, transversal en 138 pacientes de 7 a 17 años de edad, con PC (diplejía, hemiparesia) parálisis braquial obstétrica (PBO) y otros; con compromiso funcional leve o moderado, atendidos en el Instituto Teletón Santiago-Chile. Nueve terapeutas ocupacionales entrenados, aplican PBM-400 en condiciones estandarizadas, evaluando movilidad manual, prensión y/o desplazamiento, actividades funcionales y fuerza prensora con dinamómetro, vigorímetro y pinzómetro. Resultados: El 62,5 por ciento de los pacientes con diplejía y el 100 por ciento de los pacientes con polineuropatías, registran lateralidad derecha. Según compromiso funcional, predomina lateralidad derecha. La dimensión de menor rendimiento fue fuerza prensora para todos los diagnósticos y en los casos con predominio de lateralidad manual derecha, fue la dimensión de actividades funcionales. Se registraron diferencias significativas de funcionalidad de mano según diagnóstico y compromiso funcional, independiente de lateralidad. La edad y sexo no influyen en funcionalidad manual en el conjunto de niños con diversos diagnósticos. Conclusiones: La pauta Bilan 400 puntos modificada, logra discriminar significativamente la funcionalidad manual según lateralidad, diagnóstico y compromiso funcional, constituyéndose en una escala genérica para la toma de decisiones terapéuticas.

Tuberculosis pulmonar primaria en una paciente inmunocompetente con patrón clínico-radiológico de neumonía / No disponible

No disponible

[Effects of the consumption of Phlebodium Decumanum on plasma cortisol and testosterone levels in subjects participating in an exercise program]. / Efecto del Phlebodium Decumanum sobre los cambios en niveles plasmáticos de testosterona y cortisol inducidos por el ejercicio en sujetos no entrenados.

BACKGROUND: Phlebodium Decumanum is a type of fern that could have an immune or stress response modulating action. AIM: To evaluate if the consumption of a preparation obtained from Phlebodium Decumanum, modifies the changes induced by exercise in plasma levels of testosterone and cortisol. MATERIAL AND METHODS: Fourteen male subjects aged 22 +/- 2 years were randomized to consume Phlebodium Decumanum and 10 subjects, aged 23 +/- 1 years were ascribed to consume a placebo. Both groups performed a standard exercise program, three times a week during one month. Plasma free testosterone and cortisol levels were measured before and 48 hours after the last session of the exercise program. RESULTS: Cortisol levels increased significantly from 18.9 +/- 6.8 to 26.2 +/- 5.9 fig/dl, in the control group. In the group consuming the study product, no changes were detected (20.0 +/-4.6 and 20.9 +/- 5.9) fig/dl before and after the exercise program, respectively). Plasma free testosterone decreased significantly in both groups from 36.1 +/- 11.04 to 20.7 +/-4.3 pg/ml in the control group and from 33.7 +/- 10.0 pg/ml to 18.6 +/- 4.9 pg/ml in study group. CONCLUSIONS: The cortisol levels increased significantly in the control group but not in the study group. Therefore we can suggest that consumption of Phlebodium Decumanum would be able to modulate the response of this hormone to physical stress.

Parámetros de normalidad en fuerzas de prensión de mano en sujetos de ambos sexos de 7 a 17 años de edad / Normal parameters in hand grasping strength in subjects of both genders, 7 to 17 years of age

Introduction: Determining normal parameters in hand grasping strength will allow to determine clinical conditions and treatment results in patients with changes in hand dexterity. Purpose: Establish ranges of normal strength in three types of grasp in subjects of both genders, ages 7 to 17. Materials and Methods: 753 random subjects selected from schools in the Metropolitan Region, two-stage sampling, 2.12 percent error. The following tests were performed: cylindrical palmar (dynamometer), spherical palmar (vigorimeter), and subterminolateral clasp prehension (clasp). Means tests with 95 percent confidence were calculated. Results: 96.1 percent women and 95.6 men were right hand dominant. For cylindrical test, strength increased from 10.3 to 25 kg average at 17 years of age in women, in men in increased slowly up to 12 years of age reaching 39 kg at the end of the study. Spherical prehension showed slow, gradual increase reaching 0.45 bar in women and 0.65 bar in men at 17 years of age. Clasp at 17 years of age was 6.9 and 9.5 kg for women and men respectively. Conclusions: When the right hand is dominant, it is at least 6 percent stronger in clasp than the left hand in women, 5 percent in fist and clasp in men, with a 95 percent confidence between gender between the ages of 7 and 17. These data could be used as reference in patients with pathology that compromises dexterity in urban areas.

Introducción: Determinar parámetros de normalidad de fuerzas de prensión, permitirá objetivar condiciones clínicas y resultados de tratamientos en pacientes con alteraciones de funcionalidad manual. Objetivo: Establecer rangos de normalidad de fuerza en tres tipos de prensión en sujetos de ambos sexos de 7-17 años cumplidos. Materiales y Método: 753 sujetos seleccionados aleatoriamente de colegios de Región Metropolitana, en muestreo bietápico con 2,12 por ciento de error. Se evaluó prensión palmar cilíndrica (dinamómetro), palmar esférica (vigorímetro) y pinza sub-terminolateral (pinzómetro); se probó normalidad estadística para establecer intervalos de confianza de 95 por ciento para las medias. Resultados: 96,1 por ciento de mujeres y 95,6 por ciento de varones declararon mano derecha como dominante. Para prensión cilíndrica, la fuerza creció desde 10,3 hasta 25 kg promedio a los 17 a±os en mujeres; en varones, aumentó lentamente hasta los 12 años, alcanzando 39 kg promedio a igual edad. Prensión esférica presentó crecimiento lento y gradual obteniendo 0,45 bar en mujeres y 0,65 bar en varones de 17 años. En pinza, los valores promedio a la edad máxima, alcanzaron 6,9 y 9,5 kg para mujeres y hombres respectivamente. Conclusión: la mano derecha cuando es considerada dominante, tiene a lo más, un 6 por ciento de fuerza en pinza mayor que la izquierda en mujeres y de 5 por ciento en fuerza de puño y pinza en hombres; los intervalos con 95 por ciento de confianza para las prensiones estudiadas según género de 7 a 17 años de edad, pueden constituirse en patrones de referencia al comparar las fuerzas de prensión en pacientes con patologías que comprometan función manual con la población normalmente desarrollada de áreas urbanas.

Efecto del Phlebodium Decumanum sobre los cambios en niveles plasmáticos de testosterona y cortisol inducidos por el ejercicio en sujetos no entrenados / Effects of the consumption of Phlebodium Decumanum on plasma cortisol and testosterone levels in subjects participating in an exercise program

Background: Phlebodium Decumanum is a type of fern that could have an immune or stress response modulating action. Aim: To evaluate if the consumption of a preparation obtained from Phlebodium Decumanum, modifies the changes induced by exercise in plasma levels of testosterone and cortisol. Material and methods: Fourteen male subjects aged 22 ± 2 years were randomized to consume Phlebodium Decumanum and 10 subjects, aged 23 ± 1 years were ascribed to consume a placebo. Both groups performed a standard exercise program, three times a week during one month. Plasma free testosterone and cortisol levels were measured before and 48 hours after the last session of the exercise program. Results: Cortisol levels increased significantly from 18.9 ± 6.8 to 26.2 ± 5.9 fig/dl, in the control group. In the group consuming the study product, no changes were detected (20.0 ±4.6 and 20.9 ± 5.9) fig/dl before and after the exercise program, respectively). Plasma free testosterone decreased significantly in both groups from 36.1 ± 11.04 to 20.7 ±4.3 pg/ml in the control group and from 33.7 ± 10.0 pg/ml to 18.6 ± 4.9 pg/ml in study group. Conclusions: The cortisol levels increased significantly in the control group but not in the study group. Therefore we can suggest that consumption of Phlebodium Decumanum would be able to modulate the response of this hormone to physical stress.