Absceso periamigdalino bilateral. Reporte de un caso y revisión de las controversias en el diagnóstico y tratamiento / Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management

La presentación bilateral del absceso periamigdalino es poco frecuente. Su abordaje es controversial y se discute si realizar amigdalectomía en caliente versus diferida. Se presenta el caso de un paciente de sexo masculino, de 14 años, con odinofagia, trismo y fiebre. Presentaba hipertrofia amigdalina bilateral, pilares abombados y edema de paladar blando. Tomografía computada: hipertrofia amigdalina bilateral, con realce poscontraste, ambas con colección, edema con moderada estenosis faríngea. Se decidió internación para tratamiento endovenoso y amigdalectomía con drenaje bilateral. Resolución completa del cuadro con alta a las 48 horas. Ante la presencia de un absceso periamigdalino, debe considerarse la posibilidad de un absceso contralateral oculto. Debe ser diagnosticado y tratado adecuadamente para prevenir complicaciones. La amigdalectomía en caliente podría ser un tratamiento seguro y debería ser considerado en pacientes que serán sometidos a anestesia para drenaje. La decisión final debe ser determinada para cada caso en particular.

The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.

Current status and thought of transcatheter mitral edge-to-edge repair in the treatment of hypertrophy cardiomyopathy / 中华外科杂志

Septal reduction therapies, which include septal myectomy and alcohol septal ablation and so on, are the current treatment strategies for patients with obstructive hypertrophic cardiomyopathy and drug-refractory symptoms. With the deepening of theoretical understanding and the rapid development of interventional therapies, some researchers have tried to perform transcatheter mitral valve edge-to-edge repair to treat high-risk patients with hypertrophic cardiomyopathy, including obstructive and non-obstructive. The reported results are relatively satisfactory, but many urgent problems need to be solved, such as the lack of data on animal experiments and large cohort studies, and the unknown medium- and long-term outcomes. However, transcatheter mitral valve edge-to-edge repair brings new ideas for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. On one hand, it can be used as a monotherapy, on the other hand, it can be combined with novel molecular targeted drug therapy or emerging minimally invasive surgical procedures targeting hypertrophic ventricular septum, which deserves our further attention and exploratory research.

Is the myonuclear domain ceiling hypothesis dead?

Muscle fibres are multinuclear cells, and the cytoplasmic territory where a single myonucleus controls transcriptional activity is called the myonuclear domain (MND). MND size shows flexibility during muscle hypertrophy. The MND ceiling hypothesis states that hypertrophy results in the expansion of MND size to an upper limit or MND ceiling, beyond which additional myonuclei via activation of satellite cells are required to support further growth. However, the debate about the MND ceiling hypothesis is far from settled, and various studies show conflicting results about the existence or otherwise of MND ceiling in hypertrophy. The aim of this review is to summarise the literature about the MND ceiling in various settings of hypertrophy and discuss the possible factors contributing to a discrepancy in the literature. We conclude by describing the physiological and clinical significance of the MND ceiling limit in the muscle adaptation process in various physiological and pathological conditions.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Sobrecrecimiento lateral aislado - caracterización auxológica y clínico-radiológica de una cohorte de 76 casos de un único centro / Isolated lateralized overgrowth: clinical, radiological, and auxological characteristics of a single-site cohort of 76 cases

Introducción. El sobrecrecimiento lateral aislado (SLA), antes denominado hemihiperplasia/ hemihipertrofia, se refiere al sobrecrecimiento corporal lateral en ausencia de un patrón reconocible de malformaciones o síndromes genéticos. El objetivo fue analizar el crecimiento y las características clínico-radiológicas de pacientes con SLA en seguimiento en un hospital de tercer nivel en Argentina entre 1993 y 2020. Población y métodos. Estudio retrospectivo, observacional, de una cohorte de pacientes con SLA. Resultados. Se incluyeron 76 casos, 41 varones. Mediana de años de seguimiento: 5,85 (rango intercuartílico [RIC] 2,60-10,96), máximo 15,76 años. Cuarenta y ocho de 76 pacientes presentaron sobrecrecimiento en más de un segmento corporal (SLA complejo). El puntaje Z promedio de peso al nacer de niñas de término con SLA complejo fue +0,51 (desviación estándar [DE] 0,91) (p 0,022). El crecimiento en estatura de la mayoría de los niños se ubicó entre los centilos 50 y 97 de la población de referencia. La mediana de asimetría de longitud de miembros inferiores fue 1,5 cm (RIC 1,01-2,2) en pacientes con tratamiento médico y 3,70 cm (RIC 2,953,98 cm) en aquellos que requiriero epifisiodesis. El 75 % mostró una progresión de la asimetría menor o igual a 2 cm. Ocho casos presentaron asimetría renal mayor o igual a 1 cm; 2 casos presentaron nefroblastoma: edad promedio al diagnóstico 0,75 años. Conclusiones. El crecimiento prenatal de niños con SLA es normal, excepto en niñas con SLA complejo en quienes tiende a estar aumentado. La estatura promedio se ubica en centilos altos con crecimiento normal. Se recomienda realizar cribado de tumores embrionarios en este grupo de niños.

Introduction. Isolated lateralized overgrowth (ILO), formerly referred to as hemihyperplasia/hemihypertrophy, is the overgrowth of one-half of the body to its contralateral in the absence of a recognizable pattern of malformations or genetic syndromes. Our objective was to analyze the growth clinical and radiological characteristics of patients with ILO under follow-up in a tertiary care hospital in Argentina between 1993 and 2020. Population and methods. Retrospective, observational, single cohort study of patients with ILO. Results. A total of 76 cases were included; 41 were males. Median years of follow-up: 5.85 (interquartile range [IQR]: 2.60­10.96), maximum: 15.76 years. Forty-eight of 76 patients had overgrowth compromising more than 1 body segment (complex ILO). The mean birth weight Z-score of term girls with complex ILO was +0.51 (standard deviation [SD]: 0.91) (p 0.022). Most children grew between the 50th and 97th centile of the Argentinian population height reference. The median leg length discrepancy was 1.5 cm (IQR: 1.01­2.2) in patients receiving medical treatment and 3.70 cm (IQR: 2.95­3.98 cm) in those who required epiphysiodesis. Progression of discrepancy ≤ 2 cm was observed in 75% of cases. Renal asymmetry ≥ 1 cm was observed in 8 cases; Wilms tumor was noted in 2 cases: mean age at diagnosis: 0.75 years. Conclusions. Prenatal growth of children with ILO is normal, except in girls with complex ILO, in whom it tends to be increased. The average height of boys and girls tends to be located in high centiles with normal growth over time. Embryonal tumor screening is recommended in this group of children.

Idiopathic Hypertrophic Spinal Pachymeningitis: A Case Report / Paquimeningite hipertrófica idiopática espinhal: Relato de caso

Abstract Idiopathic hypertrophic pachymeningitis is rare cause of neurological symptoms with myelopathy due to spinal cord compression. We report a case of pachymeningitis, which was manifested primarily by tetraparesis after low-energy trauma and recurrence the myelopathy symptoms after 5 years of surgery. The patient, a 19-year-old woman, was subjected to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed an unspecific inflammatory process with extensive fibrosis of the dura mater. These findings, associated with the exclusion of other causes, suggest idiopathic hypertrophic pachymeningitis.

Resumo A paquimeningite hipertrófica idiopática é uma causa rara de sintomas neurológicos apresentando mielopatia por compressão da medula espinhal. Relatamos um caso de paquimeningite com manifestação primária de tetraparesia após trauma de baixa energia e recorrência dos sintomas de mielopatia 5 anos após a cirurgia. A paciente, uma mulher de 19 anos, foi submetida a extensa investigação sem evidências de qualquer doença de base. Uma biópsia da meninge revelou processo inflamatório inespecífico com extensa fibrose da dura máter, também visualizado no período perioperatório. Esses achados, associados à exclusão de outras causas, sugerem o diagnóstico de paquimeningite hipertrófica idiopática.

Esophageal Intramural Pseudodiverticulosis / Pseudodiverticulosis intramural del esófago

Abstract A report of two cases of esophageal intramural pseudodiverticulosis, a very unusual disease, with other 240 cases reported in the entire world literature since 1960. Its etiology and pathogenesis are still not fully understood. However, it is believed that hypertrophy of the submucosal glands, with chronic inflammation, fibrosis, and consequent esophageal stenosis, causes dysphagia, which is the primary manifestation of esophageal intramural pseudodiverticulosis. The main diagnostic methods include the radiological examination of the esophagus with barium contrast (esophagogram) and esophagogastroduodenoscopy (EGD). Both reported cases were treated with endoscopic dilation, exemplifying the safety and efficacy of this therapeutic option for treating dysphagia in these individuals.

Resumen Reporte de dos casos de pseudodiverticulosis esofágica intramural, una enfermedad muy inusual, con otros 240 casos reportados en toda la literatura mundial desde 1960. Su etiología y patogenia aún no se conocen completamente; sin embargo, se cree que existe una hipertrofia de las glándulas submucosas, con inflamación crónica, fibrosis y consecuente estenosis esofágica, lo que provoca disfagia, que es la principal manifestación de la pseudodiverticulosis esofágica intramural. El examen radiológico del esófago con contraste de bario (esofagograma) y la endoscopia digestiva alta (EDA) son los principales métodos de diagnóstico. Ambos casos reportados se trataron con dilatación endoscópica, lo que ejemplifica la seguridad y eficacia de dicha opción terapéutica para el tratamiento de la disfagia en estos individuos.

Fallo muscular en la hipertrofia con entrenamiento de contra resistencia: una revisión sistemática / Muscle failure in hypertrophy with resistance training: a systematic review

RESUMEN Objetivo: Determinar cuáles son los efectos que tiene el fallo muscular en el desarrollo de la hipertrofia en el entrenamiento de contra resistencia. Métodos: Estudio de tipo revisión sistemática, es decir, de enfoque cualitativo y de diseño no experimental. Se realizó una búsqueda sistemática en cinco bases de datos (Pubmed, Google Académico, ScienceDirect, Scopus, Sportdiscus). Después de analizar 405 estudios, fue preciso considerar su utilidad y relevancia con respecto a la revisión, así como también la credibilidad o experiencia del autor en la temática. Resultados: Después del cribado correspondiente y la evaluación metodológica 9 estudios cumplieron con los criterios de inclusión, según lo obtenido de esta revisión la utilización del Fallo Muscular (FM) no mostró beneficios adicionales en el aumento de la masa muscular. Además, se mostró que no existen diferencias significativas cuando se comparan cargas altas y bajas utilizando esta variable. Conclusión: Se determinó que la variable volumen es más importante en desarrollos hipertróficos independientemente de si un ejercicio se ejecuta o no hacia el fallo muscular, asimismo, es más beneficioso para la hipertrofia cuando las repeticiones no se llevan al fallo muscular si no se dejan cerca de este.

ABSTRACT Objective: To determine what are the effects of muscle failure on the development of hypertrophy in counter resistance training. Method: It is a systematic review type of study, that is, with a qualitative approach and a non-experimental design. A systematic search was carried out in 5 databases (Pubmed, Google Scholar, ScienceDirect, Scopus, Sportdiscus). After analyzing 405 studies, it was necessary to consider their usefulness and relevance in respect of the review, as well as the credibility or experience of the author on the subject. Results: After the corresponding screening and methodological evaluation, 9 studies met the inclusion criteria, as obtained from this review, the use of Muscle Failure (FM) did not show additional benefits in increasing muscle mass. In addition, it was shown that there are no significant differences when comparing high and low loads using this variable. Conclusion: It was determined that the volume variable is more important in hypertrophic developments regardless of whether or not an exercise is executed towards muscle failure, it is also more beneficial for hypertrophy when repetitions do not lead to muscle failure but are close to it.

Entrenamiento con sobrecarga, duración de la repetición e hipertrofia: una revisión de la literatura / Resistance training, repetition duration and hypertrophy: a literature review

RESUMEN En el contexto del entrenamiento con sobrecargas, la duración de la repetición (tempo) hace referencia al tiempo total que dura una sola repetición dentro de una serie de un ejercicio, siendo el resultado de la suma entre la fase concéntrica, isométrica y excéntrica del levantamiento (o viceversa, dependiendo del ejercicio). Ha existido controversia los últimos años respecto a la duración de la repetición (y sus fases) y su impacto en la hipertrofia. El objetivo de esta revisión fue analizar los efectos de programas de entrenamiento donde se hayan comparado distintos tempos de levantamiento y su impacto en la hipertrofia. Se realizó una búsqueda de literatura en la base de datos electrónica Pubmed, con los siguientes criterios de inclusión: i) programas de entrenamiento que induzcan fallo volitivo, ii) que los estudios se hayan realizado bajo acciones dinámicas y con ≥4 semanas de intervención y iii) que los sujetos de estudio sean mayores de 18 años hasta mediana edad. De un total de 473 estudios, cuatro fueron incluidos, donde participaron 113 sujetos (79 hombres y 34 mujeres) y los tempos utilizados variaron entre 1.5 y 90 segundos, con menores tempos asociados a mayor efecto hipertrófico. Un tiempo entre 2 y 6 segundos sería efectivo para inducir adaptaciones hipertróficas.

ABSTRACT In overload training the duration of the repetition (tempo) refers to the total time that a single repetition lasts within a set, the result being the sum between the concentric, isometric and eccentric phases of the lift (or vice versa depending on the exercise). There has been controversy in recent years regarding the duration of the repetition (and its phases) and its impact on muscle hypertrophy. The objective of this review was to analyze the effects of training programs and compare the different lifting tempos and their impact on hypertrophy. A literature search was carried out in the Pubmed electronic database, with the following inclusion criteria: i) training programs that induce volitional failure, ii) studies had been carried out under dynamic actions and with ≥4 weeks of intervention, and iii) study subjects are older than 18 years old to middle age. Of a total of 473 studies, four were included, where, 113 subjects (79 men and 34 women) participated and the tempos varied between 1.5 and 90 seconds, with lower tempos associated with a greater hypertrophic effect. A tempo between 2 and 6 seconds would be effective in inducing hypertrophic adaptations.

Percentage of tonsil hypertrophy in orthodontic patients with different sagittal skeletal relationship / 中华口腔医学杂志

Objective: To investigate the prevalence of tonsil hypertrophy in patients with different sagittal skeletal craniofacial patterns, as well as the correlation between tonsil hypertrophy and the type of skeletal pattern. Methods: Lateral cephalograms of patients who visited the Department of Orthodontics Division 1, School of Stomatology, Wuhan University during January to August, 2019 were retrospectively collected. Patients (children: age≥6 and ≤12 year; adults: age≥18 year) were divided into three groups according to the ANB (subspinale-nasion-supramental) angle: the skeletal class Ⅰ group (0°≤ANB≤4°), skeletal class Ⅱ group (ANB>4°) and skeletal class Ⅲ group (ANB<0°). Tonsil hypertrophy was diagnosed with lateral cephalogram by two specifically trained orthodontists independently, according to the Baroni's method. The between-group differences in tonsil hypertrophy prevalence were analyzed using chi-square tests with Bonferroni correction (α=0.017). Results: A total of 1 776 patients (593 children and 1 183 adults) were included, among which 672 (37.8%) were with class Ⅰ, 849 (47.8%) with class Ⅱ, and 255 (14.4%) with class Ⅲ skeletal pattern. The prevalence of tonsil hypertrophy in children was 66.3% (393/593). The proportion of children with tonsil hypertrophy in class Ⅲ group [87.0% (60/69)] were significantly higher than that in class Ⅰ [65.6% (145/221), χ²=11.56, P<0.017] and class Ⅱ [62.0% (188/303), χ²=15.69, P<0.017] groups. The prevalence of tonsil hypertrophy in adults was 23.2% (275/1 183). The proportion of adults with tonsil hypertrophy in class Ⅲ group [42.5% (79/186)] was significantly higher than that in class Ⅰ [19.1% (86/451), χ²=36.50, P<0.017] and class Ⅱ [20.2% (110/546), χ²=35.00, P<0.017] groups. However, there was no significant difference in the prevalence of tonsil hypertrophy between class Ⅰ and class Ⅱ groups for both children (χ²=0.70, P>0.017) and adults (χ²=0.18, P>0.017). Conclusions: The prevalence of tonsil hypertrophy in skeletal class Ⅲ patients was significantly higher than that in patients with skeletal class Ⅰ and Ⅱmalocclusion. Tonsil hypertrophy could be an important risk factor for skeletal class Ⅲ patients.

Preliminary experience of surgical treatment for torus tubarius hypertrophy in children / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. Methods: From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Results: Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). Conclusions: TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.

Enfermedad relacionada con IgG4, según criterios ACR/EULAR 2019 sin evidencia de IgG4 en sangre / IgG4-related disease according to ACR/EULAR 2019 criteria without evidence of IgG4 in blood

INTRODUCCIÓN. La enfermedad relacionada con IgG4 es una patología fibroinflamatoria multiorgánica, de origen desconocido, que simula trastornos malignos, infecciosos e inflamatorios. Los criterios del American College of Rheumatology y la European League against Rheumatism 2019, son útiles para el diagnóstico diferencial de ésta enfermedad cuando se no se cuenta con evidencia de inmunoglobulina G4 en sangre. CASO CLÍNICO. Paciente hombre de 45 años de edad, nacido en Ambato-Ecuador, con ingreso en noviembre del 2017, en emergencias del Hospital de Especialidades Carlos Andrade Marín, con presencia de tos con hemoptisis leve, febrícula, astenia, pérdida de peso e hiporexia de dos semanas de evolución. Se realizó múltiples exámenes, tras observar infiltrados pulmonares intersticiales, con elevación de inmunoglobulina G en suero, negativas para malignidad; se sospechó de enfermedad relacionada a inmunoglobulina G4. Se ampliaron los estudios para descartar otras patologías más prevalentes y cuyo diferencial es primordial. Se inició tratamiento con prednisona y micofenolato con buena respuesta clínica; durante dos años. DISCUSIÓN. La evidencia científica registró que el hallazgo más importante en la enfermedad relacionada con inmunoglobulina G4 fue un aumento de sus niveles séricos. La recurrencia de la enfermedad en un órgano afectado o la aparición de un nuevo órgano involucrado pudo conducir al diagnóstico en el caso presentado. CONCLUSIÓN. La enfermedad relacionada con inmunoglobulina G4 al ser una patología heterogénea, inmunomediada, al simular otras afecciones puede retrasar el diagnóstico; se debe tener una alta sospecha clínica, si al excluir otros procesos infecciosos, autoinmunes y/o eoplásicos, hay evidencia de patología fibroesclerosante multiorgánica sin causa establecida.

INTRODUCTION. IgG4-related disease is a multiorgan fibroinflammatory pathology of unknown origin that mimics malignant, infectious, and inflammatory disorders. The criteria of the American College of Rheumatology and the European League against Rheumatism 2019 are useful for the differential diagnosis of this disease when there is no evidence of immunoglobulin G4 in blood. CLINICAL CASE. 45-year-old male patient, born in Ambato-Ecuador, with admission in November 2017, in the emergency room of the Hospital de Especialidades Carlos Andrade Marín, with the presence of cough with mild hemoptysis, fever, asthenia, weight loss and hyporexia of two weeks of evolution. Multiple tests were performed, after observing interstitial pulmonary infiltrates, with elevated serum immunoglobulin G, negative for malignancy; immunoglobulin G4-related disease was suspected. Studies were extended to rule out other more prevalent pathologies whose differential is paramount. Treatment with prednisone and mycophenolate was started with good clinical response; for two years. DISCUSSION. The scientific evidence recorded that the most important finding in immunoglobulin G4-related disease was an increase in its serum levels. Recurrence of the disease in an affected organ or the appearance of a new involved organ could have led to the diagnosis in the presented case. CONCLUSION. Immunoglobulin G4-related disease, being a heterogeneous, immune-mediated pathology, by simulating other conditions may delay diagnosis; a high clinical suspicion should be maintained if, when other infectious, autoimmune and/or neoplastic processes are excluded, there is evidence of multiorgan fibrosclerosing pathology without established cause.

Mastoplastia de reducción con la técnica de pedículo inferior en pacientes con hipertrofia mamaria / Reduction mastoplasty by means of the inferior pedicle technique in patients with mammary hypertrophy

Introducción: La mastoplastia de reducción mediante la técnica de pedículo inferior es una de las intervenciones quirúrgicas estéticas más empleadas para corregir la hipertrofia mamaria. Objetivo: Caracterizar a las pacientes con hipertrofia mamaria, a quienes se les practicó mastoplastia de reducción con la técnica de pedículo inferior. Métodos: Se realizó un estudio descriptivo, observacional, transversal y retrospectivo de 185 pacientes entre 10 y 59 años de edad, con diagnóstico de hipertrofia mamaria, atendidas en el Servicio de Cirugía Plástica y Caumatología del Hospital General Docente Octavio de la Concepción y de la Pedraja del municipio de Baracoa, a las cuales se les practicó mastoplastia de reducción por técnica de pedículo inferior, desde enero de 2004 hasta diciembre 2020. Resultados: En la serie predominaron las féminas entre 30-39 años de edad (42,8 %), los resultados estéticos evaluados de buenos (90,3 %), las complicaciones escasas (20,0 %), con primacía de la necrosis de la piel en el punto inferior de unión de los colgajos (7,0 %) y las pacientes satisfechas con el proceder (93,5 %). El tejido glandular resecado varió entre menos de 300 g y más de 1 200, según el grado de hipertrofia. Conclusiones: La técnica de reducción mamaria a pedículo inferior es versátil, segura y aplicable a todo tipo de hipertrofia, con una tasa de complicaciones baja; asimismo ofrece resultados estéticos favorables y alto grado de satisfacción.

Introduction: The reduction mastoplasty by means of the inferior pedicle technique is one of the most used cosmetic surgical interventions to correct mammary hypertrophy. Objective: To characterize the patients with mammary hypertrophy to whom reduction mastoplasty was practiced with the inferior pedicle technique. Methods: A descriptive, observational, cross-sectional and retrospective study of 185 patients between 10 and 59 years, with diagnosis of mammary hypertrophy was carried out. They were assisted in the Plastic Surgery and Caumatology Service of Octavio de la Concepción y de la Pedraja Teaching General Hospital from the municipality of Baracoa, to whom reduction mastoplasty by inferior pedicle technique was practiced, from January, 2004 to December, 2020. Results: In the series there was a prevalence of the females between 30-39 years (42.8 %), the cosmetic results with good evaluation (90.3 %), few complications (20.0 %), with primacy of the skin necrosis in the inferior space of the flap union (7.0 %) and the patients satisfied with the procedure (93.5 %). The dried up glandular tissue varied in less than 300 grams and more than 1 200, according to the degree of hypertrophy. Conclusions: The mammary reduction technique to inferior pedicle is versatile, safe and applicable to all types of hypertrophy, with a low rate of complications; also it offers favorable cosmetic results and high degree of satisfaction.

Efeitos do treinamento de força com intensidade autosselecionada em paciente pós cirurgia bariátrica: um estudo de caso / Strenght training with self-selected intensity on a pacient post bariatric surgery

A prescrição de exercícios físicos em intensidades moderada e alta, para indivíduos obesos, pode induzir maiores percepções de desconforto/desprazer e, consequentemente, desencorajá-los a aderir a uma rotina de exercícios físicos. O objetivo deste trabalho foi investigar os efeitos de um programa de treinamento de força com intensidade autosselecionada, na composição corporal, hipertrofia e qualidade do sono de uma voluntária recémsubmetida a cirurgia bariátrica (idade: 28 anos; altura: 158cm; peso: 69 kg; índice de massa corporal: 27,64). A voluntária realizou um programa de treinamento de força com intensidade autosselecionada, pelo período de oito semanas (2 sessões semanais). Foi avaliada a qualidade de sono, por meio do questionário Pittsburgh sleep quality index; a composição corporal, por absorciometria de feixe duplo; e, a espessura muscular e do tecido adiposo, por ultrassonografia; antes e após a intervenção. Antes e após as sessões de treinamento, a percepção de prazer/desprazer foi mensurada com o auxílio de uma escala de valência afetiva. O programa de exercícios com intensidade autosselecionada resultou em uma diminuição de 2% no percentual de gordura, e de 7% na massa corporal total; sem modificação para a massa livre de gordura. Houve redução de 22% na espessura do tecido adiposo, e de 11% na espessura muscular do bíceps braquial; de 28% na espessura do tecido adiposo, e de 4% na espessura muscular do vasto lateral. A voluntária reportou percepção de prazer/desprazer positiva na maioria das sessões. No entanto, não houve diferença significativa entre os resultados para qualidade de sono. O treinamento com intensidade autosselecionada promoveu respostas positivas, relacionadas à percepção de prazer/desprazer, além de favorecer uma tendência à perda significativa de massa corporal total, sem prejuízos para a massa magra.(AU)

The prescription of physical exercise in moderate and high intensities for obese individuals may induce greater perceptions of discomfort/displeasure, consequently, decline adherence to a physical exercise routine. The objective of this study was investigate the effects of a strength training program with self-selected intensity, body composition, hypertrophy and sleep quality of a participant recently bariatric surgery (age: 28 years; height: 158cm; weight: 69 kg; body mass index: 27.64). The participant performed a strength training program with self-selection intensity, for a period of eight weeks (2 weekly sessions). Sleep quality was evaluated using the Pittsburgh sleep quality index questionnaire; body composition, by dual-energy x-ray absorptiometry, muscle and adipose tissue thickness by ultrasound. Each measure was before and after the intervention. Before and after the training sessions, the perception of pleasure/displeasure was measured with the affective valence scale. The exercise program with self-selected intensity resulted in a 2% decrease in fat percentage, and 7% in total body mass; without modification to the fat-free mass. Yet, there was a reduction of 22% in the thickness of adipose tissue, and 11% in the muscle thickness of the brachial biceps; 28% in the thickness of adipose tissue, and 4% in the muscle thickness of the vastus lateralis. The participant reported a perception of positive pleasure in most sessions. However, there was no significant difference between the results for sleep quality. The training with self-selected intensity promoted positive responses, related to the perception of pleasure/displeasure, besides promote a tendency to significant loss of total body mass, without damage to lean mass. (AU)

Guía de Práctica Clínica de estenosis hipertrófica del píloro / Clinical Practice Guidelines in Hypertrophic Pyloric Stenosis

La estenosis hipertrófica del píloro es una enfermedad que se presenta fundamentalmente en lactantes, ocurre por un estrechamiento del canal pilórico debido a la hipertrofia gradual de la capa muscular de su esfínter, lo que origina un síndrome pilórico. El objetivo de esta publicación es presentar una actualización sobre el tema. La etiología de la enfermedad es desconocida, la tendencia actual es que se trata de una enfermedad que no es congénita y se sugiere un origen multifactorial, donde influyen factores genéticos y ambientales. Su síntoma fundamental son los vómitos no biliosos y el diagnostico se complementa con el ultrasonido abdominal. El tratamiento de elección es quirúrgico y sus resultados generalmente satisfactorios. La aprobación de esta guía por los servicios de cirugía pediátrica del país la convierten en un útil instrumento asistencial y docente(AU)

Hypertrophic Pyloric Stenosis is a disease that occurs mainly in infants, caused by a narrowing of the pyloric channel due to the gradual hypertrophy of the muscle layer of the sphincter, which originates a pyloric syndrome. The aim of this publication is to present an update on the topic. The etiology of the disease is unknown, the current trend is that it is a disease that is not congenital and a multifactorial origin is suggested, where genetic and environmental factors influence. Its main symptom is non-bilious vomiting and diagnosis is supplemented with abdominal ultrasound. The treatment of choice is the surgical one and its results are generally satisfactory. The approval of this guidelines by the country's pediatric surgery services makes it a useful care and teaching tool(AU)

Resolución de hipertrofia de labios menores mediante técnicas simples / Resolution of hypertrophy of the labia minora using simple techniques

Introducción. La hipertrofia de los labios menores se define como tejido labial que sobresale más allá de los labios mayores, puede afectar de manera uni- o bilateral y resultar en dispareunia, interferencia con los deportes, dificultades con la limpieza, irritación e infecciones crónicas del tracto urinario, incomodidad para el uso de prendas ajustadas, además de trastornos psicológicos. Todos estos motivos llevan a las mujeres a la consulta. La reducción de labios menores es el procedimiento estético genital femenino más común. Este trabajo tiene como objetivo presentar técnicas de baja complejidad para resolver diferentes grados de hipertrofia de labios menores. Materiales y métodos. Estudio retrospectivo, observacional que comprendió 3 pacientes entre el periodo de marzo del 2019 a febrero 2020 que Incluyó a pacientes con hipertrofias leves y moderadas. Resultados. En 2 pacientes se realizó escisión directa y en 1, técnica del desepitelizado más lipotransferencia de labios mayores, sin evidenciar complicaciones mayores. Discusión. Si bien en la literatura se han reportado un gran número de técnicas quirúrgicas, cada una de ellas debe adecuarse al tipo de hipertrofia labial. La técnica del desepitelizado permite conservar un borde natural, con conservación de la coloración y textura original de la paciente, aporte neurovascular, pero no es conveniente utilizarla en pacientes de grados mayores de hipertrofia. La escisión directa proporciona una técnica simple para la escisión del exceso de tejido en pacientes con mayor tamaño de sus labios menores, pero elimina el contorno, la coloración y la textura naturales del borde libre, aun así, las pacientes resultan conformes con su nuevo aspecto. Conclusión. La reconstrucción de los labios menores, utilizando las técnicas de desepitelización y escisión directa, es confiable y da un resultado cosmético y funcional exitoso. Estas técnicas son de baja complejidad, tiempo operatorio breve, técnicamente reproducibles, dando gran conformidad y resultando un método seguro

Introduction. Hypertrophy of the labia minora is defined as lip tissue that protrudes beyond the labia majora, can affect unilaterally or bilaterally and result in dyspareunia, interference with sports, difficulties with cleaning, irritation and chronic infections of the urinal tract, discomfort for wearing tight clothes, in addition to psychological disorders. All these reasons lead women to the consultation. Labia minora reduction is the most common female genital cosmetic procedure. This work aims to present low complexity techniques to resolve different degrees of hypertrophy of the labia minora. Materials and methods: retrospective, observational study that comprised 3 patients between the period of March 2019 to February 2020 that included patients with mild and moderate hypertrophy. Results: Direct excision was performed in 2 patients and in 1, de-epithelialization technique plus lipotransference of the labia majora. Without showing major complications. Discussion: Although a large number of surgical techniques have been reported in the literature, each of them must be adapted to the type of lip hypertrophy. The de-epithelialization technique allows a natural border to be preserved, with preservation of the patient's original color and texture, neurovascular supply, but it is not convenient to use it in patients with higher degrees of hypertrophy. Direct excision provides a simple technique for excision of excess tissue in patients with larger labia minora, but removes the natural contour, coloration and texture of the free edge, yet patients are still satisfied with their new appearance. Conclusion. The reconstruction of the labia minora, using de-epithelialization and direct excision techniques is reliable and gives a successful cosmetic and functional result. These are low complexity techniques, short operating time, technically reproducible, giving great conformity and resulting in a safe method

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.