Laringectomía total en el adulto mayor, Guantánamo 2015-2019 / Laringectomia total em idosos, Guantánamo 2015-2019 / Total laryngectomy in older adult, Guantanamo 2015-2019

Introducción: El cáncer laríngeo en el adulto mayor tiene una incidencia elevada por múltiples factores que se incrementan con la edad, pero con un tratamiento específico adecuado como la laringectomía total permiten mejorar y elevar la calidad de vida de estos pacientes. Objetivo: Caracterizar el resultado de las intervenciones por laringectomía total realizadas en pacientes adultos mayores en el servicio de Otorrinolaringología del Hospital General Docente "Dr. Agostinho Neto", provincia Guantánamo, en el período de enero de 2015 a diciembre de 2019. Método: Se realizó un estudio descriptivo, retrospectivo de corte transversal en el total de pacientes (n=32) de 60 años y más a los que se les realizó laringectomía total durante el periodo estudiado. Las variables estudiadas fueron: edad, sexo, hábitos tóxicos, condicionantes prequirúrgicas, técnica quirúrgica y complicaciones más frecuentes. Los datos se obtuvieron de las historias clínicas. Resultados: La mayoría de los pacientes correspondió al sexo masculino (90,6 porciento) entre 70-74 años; el 71,8 porciento de los pacientes fumaba. La laringectomía total combinada con tiroidectomía unilateral o bilateral y vaciamiento cervical selectivo fue la técnica quirúrgica más empleada y el faringostoma la complicación predominante. Conclusiones: La caracterización de los resultados de la laringectomía total en el adulto mayor portador de carcinoma epidermoide laríngeo aporta datos que permiten una mejor atención integral a este grupo poblacional(AU).

Introduction: Laryngeal cancer has a high incidence in older adult due to various factors which has been increasing in frequency with age. However, assuming an adecuated and specific treatment like total laryngectomy, allows improving and enhancing the patient's quality of life. Objective: To characterize the outcomes of total laryngectomy in older adult patients treated in the otorhinolaryngology service at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo, from January 2015 to December 2019. Method: A descriptive, retrospective, and cross-sectional study was conducted on the total of patients (n=32) 60 and older, who underwent total laryngectomy during the mentioned period. Variables used were as follow: age, sex, toxic habits, preoperative conditions, surgical technique and, most frequent complications. Data was gathered from medical records. Results: Male patients 70 to 74 years were predominant (90.6 percent) and most of them smoked (71.8 percent). Total laryngectomy combined with unilateral or bilateral thyroidectomy and selective neck dissection was the most common surgical technique used and pharyngostoma was the predominant complication. Conclusions: The characterization of total laryngectomy outcomes in older adult with laryngeal squamous cell carcinoma provides important data for better comprehensive care in this population group(AU).

Introdução: O câncer de laringe em idosos apresenta alta incidência devido a múltiplos fatores que aumentam com a idade, mas com um tratamento específico adequado como a laringectomia total, melhoram e melhoram a qualidade de vida desses pacientes. Objetivo: Caracterizar o resultado da laringectomia total realizada em pacientes idosos no serviço de Otorrinolaringologia do Hospital General Docente "Dr. Agostinho Neto", província de Guantánamo, no período de janeiro de 2015 a dezembro de 2019. Método: Estudo descritivo, retrospectivo e transversal em todos os pacientes (n=32) com 60 anos ou mais que realizaram laringectomia total. durante o período estudado. As variáveis estudadas foram: idade, sexo, hábitos tóxicos, condições pré-cirúrgicas, técnica cirúrgica e complicações mais frequentes. Os dados foram obtidos dos prontuários médicos. Resultados: A maioria dos pacientes era do sexo masculino (90,6 porcento) entre 70-74 anos; 71,8 porcento dos pacientes fumavam. A laringectomia total combinada com tireoidectomia unilateral ou bilateral e dissecção cervical seletiva foi a técnica cirúrgica mais utilizada e a faringostomia a complicação predominante. Conclusões: A caracterização dos resultados da laringectomia total em idosos com carcinoma espinocelular de laringe fornece dados que permitem uma melhor assistência integral a este grupo populacional(AU).

Treatment of Dehisced, Thoracic Neonatal Wounds With Single-Use Negative Pressure Wound Therapy Device and Medical-Grade Honey: A Retrospective Case Series.

PURPOSE: The purpose of this study was to report on our experience with a portable, single-use negative pressure wound therapy device used in combination with activated active Leptospermum honey (ALH) in the treatment of colonized or infected, dehisced, thoracic wounds in neonates with complex congenital heart disease. DESIGN: Retrospective, descriptive study. SUBJECTS AND SETTING: We reviewed medical records of 18 neonates and reported on findings from 11; the remaining 7 were not included secondary to incomplete records, transfer to a different institution prior to wound healing, or death. The median age of our patients was 12 days (range, 2 days to 5 weeks); their mean gestational age was 34 weeks. All of the neonates had acquired postoperative wound dehiscence that were colonized or infected and were treated in the neonatal intensive care unit (NICU) at Cohen Children's Medical Center (New Hyde Park, New York), a regional perinatal center with a level 4 NICU. METHODS: Wound cultures were obtained on all patients prior to treatment commencement. All cultures were repeated on day 4 of treatment. Systemic antibiotics were administered as necessary. No complications were observed related to the use of negative pressure wound therapy device and ALH. All patients were followed until discharge home or transfer to another facility. The pain scores during placement and removal were acceptable (between 1 and 3; median = 2) using the Neonatal Infant Pain Scale. Staff and parents indicated that the combination of ALH and the negative pressure wound therapy device did not interfere with daily care and parental bonding. CONCLUSIONS: Use of ALH and a single-use negative pressure wound therapy device was successful in this series of 11 neonates with complex congenital heart disease.

Hyperbaric oxygen therapy improves colorectal anastomotic healing.

PURPOSE: Hyperbaric oxygen treatment (HBOT) has been found to improve the healing of poorly oxygenated tissues. This study aimed to investigate the influence of HBOT on the healing in ischemic colorectal anastomosis. METHODS: Forty Wistar rats were randomly divided into a treatment group that received HBOT for 10 consecutive days (7 days before and 3 days after surgery), or in a control group, which did not receive the therapy. Colectomy with an ischemic anastomosis was performed in all rats. In each group, the rats were followed for 3 or 7 days after surgery to determine the influence of HBOT on anastomotic healing. RESULTS: Five rats from each group died during follow-up. No anastomotic dehiscence was seen in the HBOT group, compared to 37.5 % and 28.6 % dehiscence in the control group on postoperative day (POD) 3 and 7, respectively. The HBOT group had a significantly higher bursting pressure (130.9 ± 17.0 mmHg) than the control group (88.4 ± 46.7 mmHg; p = 0.03) on POD 3. On POD 3 and POD 7, the adhesion severity was significantly higher in the control groups than in the HBOT groups (p < 0.005). Kidney function (creatinine level) of the HBOT group was significantly better than of the control group on POD 7 (p = 0.001). Interestingly, a significantly higher number of CD206+ cells (marker for type 2 macrophages) was observed in the HBOT group at the anastomotic area on POD 3. CONCLUSION: Hyperbaric oxygen enhanced the healing of ischemic anastomoses in rats and improved the postoperative kidney function.

Láser terapia de baja potencia en zona cruenta post-quirúrgica / Low power laser therapy in the post- operative bloody zone

Se realizó un estudio cuasi-experimental a pacientes sometidos a intervenciones de cirugía estética que desarrollaron como complicación la dehiscencia de la sutura teniendo como resultante una zona cruenta, en el Hospital Provincial Universitario Carlos Manuel de Céspedes de Bayamo, Granma, en el período comprendido entre enero del 2006 hasta el 30 de abril del 2009 con el objetivo de evaluar la efectividad del láser de baja potencia en la cicatrización de la zona cruenta postquirúrgica. La muestra fue de 40 pacientes, en dos grupos distribuidos de 20 cada uno, de forma aleatoria, al primero, se le aplicó cura convencional con nitrofurazona y al segundo láser terapia de baja potencia de tipo helio-neón donde se concluyó que con cura convencional a partir de la décima sesión predominaron significativamente los mejorados, no existió empeoramiento con el láser, además las pacientes de este grupo recibieron menos sesiones para la resolución total, y el resultado estético final satisfactorio prevaleció con esta modalidad(AU)

It was performed a cuasi-experimental research to patients who were under aesthetic surgical intervention, and showed as the main complication the dehiscence of the suture having a bloody zone as result, at Carlos Manuel de Cespedes University Province Hospital in Bayamo, Granma, during the period from January 2008 to January 30, 2009, with the objective to evaluate the improvement and development of a method that accelerate the cicatrization process for the resolution of the post operative bloody zone. The universe was made by all the patients surgically assisted for reductive mastoplastia, dermic mastopexy and abdominal demolipectomia. There were taken 40 patients as the sample, distributed at random into two groups of 20. The conventional cure was applied to the control group and the research group received laser irradiation from the helium neon type. In the tenth sesion of the control group the severe cases improved, in the research group the cases did not get worse and in the fifth sesion it was observed an improvement. This group received just a few sesions. The aesthetic final result was acceptable in the research group. We recommend to keep on developing the low power laser therapy making emphasis in the different stages of cicatrization(EU)

Squamous cell carcinoma occurring within incision of recently implanted spinal cord stimulator.

Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. Spinal cord stimulation has been employed in the treatment of chronic pain for more than 30 years. The most common indication for SCS is the failed back syndrome with leg pain. Its indications have expanded beyond back and lower extremities pain to include axial low back pain, CRPS, mesenteric ischemia, peripheral neuropathy, limb ischemia, and refractory angina pectoris. The SCS has become a more versatile form of analgesia. The number of wound complications will surely rise in conjunction with the increasing number of devices being implanted. We describe a case of a well-differentiated squamous cell carcinoma occurring within the incision site of a recently implanted spinal cord stimulator early in the postoperative period. The patient developed a rapidly growing mass within the leads incision. The mass was confirmed to be squamous cell carcinoma by biopsy. The mass was excised under local anesthesia with appropriate margins. It was determined that the carcinoma did not extend below the dermis, and that there was no involvement of the underlying fascia. The device was tested for proper functioning, and the leads were thus left in place. While the development of skin malignancies in surgical wounds has been described in the literature, to our knowledge there have been no reports of a cutaneous neoplasm developing early in the postoperative period after spinal cord stimulator implantation.

Treatment of surgical wound dehiscence.

Surgical exploration of cavities, sinuses, and specific antibiotic therapy are fundamental for the control fo cutaneous infection. Topical treatment will vary based on evaluation of the lesion, experience of the health care team, and the environment.

Topical application of honey in treatment of abdominal wound disruption.

The usefulness of honey application as an alternative method of managing abdominal wound disruption was assessed. Fifteen patients whose wound disrupted after Caesarean section were treated with honey application and wound approximation by micropore tape instead of the traditional method of wound dressing with subsequent resuturing. We achieved excellent results in all the cases with complete healing within 2 weeks. Honey application is inexpensive, effective and avoids the need to resuture which also requires general anaesthesia.

[Complete intestinal lavage in the complex treatment of incompetence of large intestine anastomoses]. / Polnoe kishechnoe promyvanie v kompleksnom lechenii nesostoiatel'nosti tolstokishechnykh anastomozov.

The work gives substantiation of using complete intestinal lavage for certain indications in the complex treatment of incompetent colonic anastomoses. The method was efficiently used in 6 patients.