Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts.

A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice. We present a case (with video) that shows the complete resection of a type I choledochal cyst with Roux-en-Y reconstruction of two separate ducts since the right posterior duct reached the cyst independently. The laparoscopic approach offers all the advantages of mini-invasive surgery and better visualization of the structures; however, biliary reconstruction to fine ducts implies a surgical challenge that requires high training in mini-invasive surgery.

Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery.

Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication. We present the case of a 33-year-old female patient who had previously undergone laparoscopic sleeve gastrectomy in 2014 and subsequently developed portal thrombosis, followed by cavernomatosis and associated complications of portal hypertension. A proximal splenorenal shunt procedure and splenectomy were successfully performed to manage portal hypertension. The presentation of this clinical case aims to contribute to the available evidence and knowledge surrounding this rare and challenging pathology.

Acalasia o hipertrofia del músculo Cricofaríngeo: opciones de tratamiento

La disfagia alta es un síntoma frecuente de consulta al otorrinolaringólogo o gastroenteròlogo. Los diagnósticos diferenciales son trastornos de la deglución por daño neurològico, anillos esofágicos superiores, globus faríngeo, neoplasia, disfagia lusoria y trastornos motores inespecífico y otras más raras aún. Hay escasa literatura actualizada en pacientes adultos. El diagnóstico se basa en el estudio radiológico baritado, endoscopia y complementariamente con manometría. Las opciones de tratamiento son motivo de discusión, dada la poca evidencia disponible. En este artículo se presentan los resultados observados en una cohorte de 10 pacientes con diagnóstico confirmado de acalasia del cricofaríngeo sometidos a dilatación endoscópica (7 pacientes) o miotomía quirúrgica por cervicotomía (3 pacientes). Se evaluó evolución de la disfagia, complicaciones post procedimiento y resultados a largo plazo. No hubo complicaciones mayores, la disfagia mejoro en ambos grupos, en el grupo de dilatación se complementó el tratamiento con dilataciones periódicas en 2 pacientes. No hubo diferencias significativas en los 2 grupos estudiados. Conclusión: ambas opciones terapéuticas presentan buenos resultados en el tratamiento de estos pacientes.

Dysphagia at cervical level is a frequent symptom causing visit to otolaryngologist or gastroenterologist. The differential diagnoses are swallowing disorders due to neurological damage, upper esophageal rings, pharyngeal globus, neoplasia, non-specific motor disorders and other even rarer ones. There is little updated literature in adult patients. The diagnosis is based on the barium radiological study, endoscopy and complementary manometry. Treatment options are a matter of discussion, given the little evidence available. This paper presents the results observed in a cohort of 10 patients with a confirmed diagnosis of cricopharyngeal achalasia who underwent endoscopic dilation (7 patients) or surgical myotomy by cervicotomy (3 patients). The evolution of dysphagia, post-procedure complications and long-term results were evaluated. There were no major complications, dysphagia improved in both groups, in the dilation group the treatment was supplemented with periodic dilations in 2 patients. There were no significant differences in the 2 groups studied. Conclusion: both therapeutic options present good results in the treatment of these patients.

Remisión a largo plazo de la hipertensión portopulmonar mediante trasplante hepático en paciente con cirrosis asociada a hepatitis autoinmune / Long term remission of portopulmonary hypertension with liver transplantation in a patient with cirrhosis associated to autoimmune hepatitis

La hipertensión portopulmonar (HTPP) es una complicación infrecuente de la hipertensión portal, que sigue un curso progresivo con un pronóstico sombrío. Los reportes en pacientes pediátricos son escasos y con períodos de seguimiento cortos. Se describe una paciente con cirrosis descompensada que desarrolló HTPP resuelta mediante trasplante hepático, que permanece asintomática tras diez años de seguimiento.

Portopulmonary hypertension is an uncommon complication of portal hypertension, running a progressive course with a negative prognosis. Reports in pediatric patients are scarce with short follow up. We describe the case of decompensated cirrhosis who developed PoPH and resolved with liver transplantation, remaining asymptomatic after ten years of follow up.

Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome.

CASE SERIES SUMMARY: The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named 'patellar fracture and dental anomaly syndrome' (PADS), also known previously as 'knees and teeth syndrome'. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. RELEVANCE AND NOVEL INFORMATION: Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required.

Incidence and types of preceding and subsequent fractures in cats with patellar fracture and dental anomaly syndrome.

OBJECTIVES: The aim of this study was to document the incidence of preceding and subsequent fractures to the patellar fractures in cats with patellar fractures and dental anomaly syndrome. METHODS: Records of cats with patellar fracture and dental anomaly syndrome were retrieved from the combined databases at the University of Bristol, UK, and Exclusively Cats Veterinary Hospital, USA. A request was made to complete a questionnaire to obtain long-term follow-up of these cats with respect to their current status and fractures to other bones; radiographs and histories were requested and were reviewed for treatment of ongoing fractures and outcome. RESULTS: Of the 191 cases reported with this syndrome, 92 cats (48.2%) had dental anomalies and 78 (40.8%) had fractures to other bones; 21 cats sustained the fractures preceding the patellar fractures and 57 subsequently. In total, there were 175 fractures: acetabulum (25%), tibia (22%), ischium (15.4%), humeral condyle (13.7%), calcaneus (5.1%), ilium (5.1%), pubis (3.4%) and other bones (10.2%). The majority of these fractures were characteristic of insufficiency (stress) fractures with a very similar configuration in each bone. CONCLUSIONS AND RELEVANCE: A high proportion of cats with patellar fracture and dental anomaly syndrome will have preceding or subsequent fractures to their patellar fractures. In this study, >10% of cats suffered characteristic fractures preceding the patellar fractures. The presence of these fractures should alert the veterinarian to the possibility that the cat is affected by patellar fracture and dental anomaly syndrome.

Prevalencia del Síndrome de Burnout académico en el estudiantado de Enfermería de la Universidad de Costa Rica / Burnout syndrome prevalence in academic nursing student at the University of Costa Rica / Prevalência da Síndrome de Burnout acadêmico nos estudantes de Enfermagem da Universidade de Costa Rica

ResumenIntroducción.El síndrome de Burnout se suele investigar más en el área laboral, sin embargo quienes trabajan no son los únicos individuos que sufren de este síndrome, también muchos estudiantes se encuentran inmersos en esta situación, debido a la carga tanto académica como personal que requiere cumplir con todos los requisitos universitarios.Metodología. La población está formada por el estudiantado de la carrera de Licenciatura en Enfermería, de Escuela de Enfermería de la Universidad de Costa Rica. El diseño metodológico es cuantitativo, no experimental, con alcance descriptivo transeccional.Resultado. el 18,8% de la población estudiada presenta el sindromé de Burnout académicoConclusión.la mayoría de la población presenta síntomas físicos como dolores de cabeza, trastornos del sueño y problemas osteomusculares. Además de síntomas conductuales como irritabilidad, nerviosismo, sentimientos de vacío y soledad, y síntomas cognoscitivos, como dificultad para concentrarse y mayor sensibilidad a la crítica que a la larga pueden ser el camino abierto a otros padecimientos tanto físicos como psiquiátricos.

AbstractIntroduction.The burnout syndrome is usually more researched in the workplace, but those working are not the only individuals who suffer from this syndrome, also many students are immersed in this situation, due to both academic load and personnel required to meet all university requirements.Method.The population is made by the students of the Bachelor of Nursing, School of Nursing at the University of Costa Rica. The design methodology is quantitative, not experimental, with transeccional descriptive scope.Results. 18.8% of the study population presents academic Burnout syndromeConclusion. Most of the population has physical symptoms such as headaches, sleep disorders and musculoskeletal problems. In addition to behavioral symptoms such as irritability, nervousness, feelings of emptiness and loneliness, and cognitive symptoms such as difficulty concentrating and increased sensitivity to criticism that eventually may be open to other ailments both physical and psychiatric way.

ResumoIntrodução. A síndrome de Burnout é investigada mais na área trabalhista, no entanto, as pessoas que trabalham não são os únicos indivíduos que sofrem desta síndrome, também muitos estudantes se encontram imersos nesta situação, devido a carga tanto acadêmica como pessoal que requerem para cumprir com todos os requisitos universitários.Método. A população está formada por estudantes da carreira de Licenciatura em Enfermagem, da Escola de Enfermagem da Universidade de Costa Rica. O desenho metodológico é quantitativo, não experimental, com alcance descritivo transeccional.Resultado. 18,8% da população estudada apresenta a síndrome de Burnout acadêmicoConclusão. A maioria da população apresenta sintomas físicos como dores de cabeça, trastornos do sono e problemas osteomusculares. Ademais dos sintomas de conduta como irritabilidade, nervosismo, sentimentos de vazio e solidão, e sintomas cognoscitivos, como dificuldade para se concentrar e maior sensibilidade a crítica que com o tempo, podem se tornar caminho aberto a outros padecimentos tanto físicos como psiquiátricos.

Géneros discursivos y errores más frecuentes en los informes académicos de estudiantes de enfermería / Discourse genres and most frequent mistakes in academic reports of nursing students

Objetivo. Describir los géneros discursivos y los errores más comunes en la construcción de textos académicos por los estudiantes de enfermería de la Pontificia Universidad Católica de Chile. Metodología. Estudio cualitativo realizado en 2006 en el que se seleccionaron 68 informes (27 individuales y 41 grupales), para identificar, por una parte, el género predominante en cada texto se realizó la caracterización de los informes, atendiendo a criterios textuales, discursivos y pragmáticos; y por otra parte, para evaluar los errores más frecuentes. Para este efecto, se tuvo en cuenta el curso de procedencia. Las categorías de problemas o errores se obtuvieron por saturación. Resultados. Los géneros discursivos utilizados frecuentemente por los alumnos son los reportes de caso y los estudios bibliográficos. Los problemas en la construcción del texto se relacionaron principalmente con: uso inadecuado de vocabulario, informalidad académica y deficiente construcción de oraciones. Conclusión. El nivel de desarrollo de habilidades de escritura es descriptivo, Las deficiencias presentadas merecen ser estudiadas con el fin de desarrollar estrategias que ayuden a superarlas.

Objective. To describe discourse genres most frequently used, and the most common mistakes in the construction of academic texts of nursing students of the Catholic University of Chile. Methodology. Qualitative study carried out in 2006. 68 papers (27 individuals and 41 groups) were chosen. To identify the main genre in each text, the paper was characterized taking into account textual, discursive and pragmatic criteria. To identify the most frequent mistakes, they were reviewed according to the course they came from. Problems or mistakes categories were obtained by saturation. Results. Discourse genres most frequently used by the students are case reports and bibliographic studies. Problems in the construction of the text were mainly linked to: inappropriate use of vocabulary, academic informality, and deficient construction of sentences. Conclusion. The level of development of writing abilities is descriptive, existing deficiencies that deserve to be studied, aiming to develop strategies to decrease this problem.

Objetivo. Descrever os gêneros discursivos mais frequentemente utilizados e os erros mais comuns na construção de textos acadêmicos dos estudantes de enfermagem da Pontifícia Universidade Católica de Chile. Metodologia. Estudo qualitativo realizado em 2006 no que se selecionaram 68 relatórios (27 individuais e 41 grupais). Para reconhecer o gênero predominante em cada texto se realizou a caracterização do relatório atendendo a critérios textuais, discursivos e pragmáticos. Para identificar os erros mais frequentes, revisaram-se de acordo ao curso do que procediam. As categorias de problemas ou erros se obtiveram por saturação. Resultados. Os gêneros discursivos mais frequentemente utilizados pelos alunos são os reportes de caso e os estudos bibliográficos. Os problemas na construção do texto se relacionaram principalmente com: uso inadequado de vocabulário, informalidade acadêmica e deficiente construção de orações. Conclusão. O nível de desenvolvimento de habilidades de escritura é descritivo, existindo deficiências que merecem ser estudadas com o fim de desenvolver estratégias que ajudem a diminuir este problema