A prospective multicenter study to evaluate the impact of cryotherapy on dysphagia and quality of life in patients with inoperable esophageal cancer.

BACKGROUND: Dysphagia palliation in inoperable esophageal cancer continues to be a challenge. Self-expandable metal stents have been the mainstay of endoscopic palliation but have a significant risk of adverse events (AEs). Liquid nitrogen spray cryotherapy is an established modality that can be used with systemic therapy. This study reports the outcomes of cryotherapy, including dysphagia and quality of life (QoL), in patients receiving systemic therapy. METHODS: This was a prospective multicenter cohort study of adults with inoperable esophageal cancer who underwent cryotherapy. QoL and dysphagia scores before and after cryotherapy were compared. RESULTS: 55 patients received 175 cryotherapy procedures. After a mean of 3.2 cryotherapy sessions, mean QoL improved from 34.9 at baseline to 29.0 at last follow-up (P < 0.001) and mean dysphagia improved from 1.9 to 1.3 (P = 0.004). Patients receiving more intensive cryotherapy (≥ 2 treatments within 3 weeks) showed a significantly greater improvement in dysphagia compared with those not receiving intensive therapy (1.2 vs. 0.2 points; P = 0.003). Overall, 13 patients (23.6 %) received another intervention (1 botulinum toxin injection, 2 stent, 3 radiation, 7 dilation) for dysphagia palliation. Within the 30-day post-procedure period, there were three non-cryotherapy-related grade ≥ 3 AEs (all deaths). The median overall survival was 16.4 months. CONCLUSION: In patients with inoperable esophageal cancer receiving concurrent systemic therapy, adding liquid nitrogen spray cryotherapy was safe and associated with improvement in dysphagia and QoL without causing reflux. More intensive treatment showed a greater improvement in dysphagia and should be considered as the preferred approach.

Donor-Site Morbidity Following Free Fibula Flap Harvest for Mandibular or Maxillary Reconstruction in Pediatric Patients.

INTRO AND AIM: The morbidity at the donor-site in the free fibula flap is a well-studied fact in the adult population, but in children, there are few reports of the long-term adverse effects at the donor site. In this study, we evaluate donor-site morbidity, complications, and functional outcome in pediatric patients undergoing free fibula flap harvest for mandibular or maxillary reconstruction, and the relation between pain and walking abilities. METHODS: A retrospective study of 22 pediatric patients undergoing free fibula flap harvest for mandibular and maxillary reconstruction between 2003 and 2014 was conducted. A certified point evaluation system was used, analyzing several factors like pain, walking ability, restriction in activities, gait alteration, paresthesia, and cosmetic appearance, and the relationship between variables. RESULTS: Mean age follow up of patient was 8.5 years (range 2-13 years). Pain was reported in 27% (n = 6), paresthesia and numbness 9% (n = 2), walking ability alteration in 50% (n = 11), restriction in activities in 18% (n = 4), gait alteration in 23% (n = 5), and cosmetic appearance alteration in the 14% (n = 3). We compare the pain and the gait alteration and did not find any relation between pain and gait alteration (P = 0.6016) and there was no relation between restriction in activities and walking ability (P = 0.1455). CONCLUSION: Free fibula flap is the gold standard for head and neck reconstruction, but the morbidity at the donor site, especially in a growing child, should not be ignored or minimized when counseling patients and their families.More studies, with more population and with a long-term follow-up should be carried out to determine the impact on the daily activities on the pediatric population.

Morbidity in Patients With Separation of Cartilaginous Framework: Temporoparietal Fascia Flap and Treatment With Dermal Regeneration Template.

BACKGROUND: The full creation of an ear requires 2 reconstruction stages. In the second stage of reconstruction, the cartilaginous framework placed at first stage is separated from the head creating an auriculocephalic sulcus. Then a piece of rib cartilage is placed in the sulcus to maintain this separation and is covered with tissue that allows the integration of a full-thickness skin graft. METHODS: A descriptive study based on the pre and postoperative medical records and photographic archives of patients diagnosed with microtia who underwent separation of the cartilaginous framework from February 2010 to July 2015 in the Plastic and Reconstructive Surgery Department at Hospital General Dr. Manuel Gea González. RESULTS: Fifty-four patients met the selection criteria. The temporoparietal fascial flap was performed on 85% (n = 46), and 8 cases with random occipito-temporal fascial flap in association to a dermal regeneration template. The average time at the operating room was 177 minutes in patients with temporoparietal fascial flap versus 84.5 minutes in dermal regeneration template. The complication rate was 25.9% (n = 14), being similar rate with both techniques. CONCLUSIONS: Coverage with dermal regeneration template and random occipito-temporal fascia flap as an alternative use instead of temporoparietal fascial flaps, offers good postoperative results, lower operating times, and similar rate of complications, with the advantage of producing no visible scars and reserve the temporoparietal fascial flap for possible exposure of the cartilaginous framework.

Anatomical Reconstruction in Bilateral Cleft Lip With Mendoza Technique.

: The bilateral cleft lip (BCL) is the most severe manifestation of orofacial clefts. Multiple techniques have been described to reconstruct BCL to obtain good aesthetic and functional results with minimal complications. OBJECTIVE: Description of surgical technique for BCL reconstruction and present the postoperative results obtained. METHODS: Patients with BCL of the cleft lip and palate at ABC Medical Center from June 2013 to June 2017 operated with Mendoza bilateral cheiloplasty were included. The procedure includes an anatomical reconstruction of the lip with minimal resection of tissue, alignment of the orbicularis muscle, vestibule creation, and complete use of the prolabium. The evaluation was carried out by photographs analyzing parameters of quality, symmetry, and alignment of lip and nose structures. RESULTS: The authors included 36 patients, 15 women and 16 men. The average procedure time was 57 minutes. Photographs were evaluated 1 year postoperatively, symmetry in lip was observed in 91.6% of the patients, muscle continuity in 100%, deep gingivolabial sulcus in 94.5% of cases, closed nasal floor in 100% with no presence of nasovestibular fistulas. CONCLUSIONS: This technique allows an anatomical BCL reconstruction with good aesthetic and functional results.

Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome.

BACKGROUND: Improvements in bile duct injury repairs have been shown in centres with specialized surgeons. The aim of the present study was to demonstrate the temporal change in the pattern of referral, technical variation associated with repair and long-term outcome of bile duct injuries at a tertiary referral centre in Mexico City. METHODS: A retrospective case note review was performed. Patients were divided into two groups: group I (GI) 1990 to 2004 and group II (GII) 2005-2008, and appropriate statistical analysis undertaken. RESULTS: Over a 20-year period, 312 patients with iatrogenic bile duct injuries required surgical treatment (GI = 169, GII = 140 patients). All injuries were reconstructed using a Roux-en-Y hepaticojejunostomy. The proportion of patients who had undergone a laparoscopic cholecystectomy increased from 24% to 36% (P = 0.017) over the two time periods. In the second time period there was an increase in segment IV and V partial resections (P = 0.020), a reduction in the use of transanastomotic stents (42% to 2%, P = 0.001) and an increase in the proportion of patients requiring a neoconfluence (2% to 11%, P = 0.003). In the second time period, the number of patients requiring a hepatectomy during repair (2% to 1%, P = 0.001), a portoenterostomy (16% to 9%, P = 0.060) or a double-barrel hepatico-jejunostomy (5% to 1%, P = 0.045) significantly decreased. During follow-up, patients in the second time period had a reduction in the incidence of post-operative cholangitis (11% to 6%, P = 0.310) and the frequency of post-operative anastomotic stenoses (13% to 5%, P = 0.010). Mortality remained low throughout the series but was absent in the second group. CONCLUSIONS: Changes in technique and growing experience of the multidisciplinary team improved operative and long-term results of bile duct injury repair.

High-energy ball milling treatment of soybean for Bacillus thuringiensis culture media.

Soybean meal has been intensively used as a substrate in culture media for several microorganisms. However, the fermentable sugar containing the soybean needs to be released from the solid matrix through different processes. Against this backdrop, the present study explores the use of high-energy ball milling as a one-step treatment method for expedited production of fermentable sugars of textured soybean. The best result is observed after only 5 min of milling, obtaining 34.1 times more fermentable sugars than untreated textured soybean, and 2.5 times more than commercially used soybean meal. Notably, the textured soybean ball-milled has been used as a substrate for Bacillus thuringiensis var. kurstaki HD-73 fermentation. The cell and spore production is also compared with a standard Rowe media. The maximum cell concentration obtained in the entire fermentation process using ball-milled textured soybean media is found to be higher than the concentration obtained using the standard Rowe media. In addition, it is observed that there is a direct correlation between maximum cell production and reducing sugar concentration generated by the high-energy ball milling treatment. No fermentation inhibitors or by-products are generated during the physical treatment.

Nerve Transfer for Facial Paralysis Under Intravenous Sedation and Local Analgesia for the High Surgical Risk Elderly Patient.

BACKGROUND: This case report describes an 86-year-old woman with complete peripheral right-sided facial paralysis resulting from resection of a cervical lipoma 14 months before surgery. CASE DESCRIPTION: Because of the high anesthetic risk, a masseter to facial nerve transfer was performed under combined light sedation and local anesthetic. Good functional and aesthetic outcomes were noted without complications. CONCLUSIONS: To our knowledge, nerve transfers under light sedation and local anesthesia have not been described in the literature and may be useful in elderly patients with significant comorbidities.

Guía de buenas prácticas del desempeño: Servicio materno infantil, salud sexual y reproductiva y planificación familiar. Primer nivel de atención / Guide to Good Practice Performance: service maternal and child sexual and reproductive health and family planning. Primary care

La presente publicación focaliza las estrategias principalmente en la atención a la salud de la población en condición de pobreza, en concordancia con las políticas y normatividad del sector salud

Frecuencia del paludismo en inmigrantes en la zona fronteriza de Chiapas / Prevalence of malaria in immigrants in the frontier zone, Chiapas

Se realizó una encusta en dos asentamientos de refugiados guatemaltecos en Ocosingo, Chiapas, para conocer la frecuencia del paludismo por especie, grupo de edad y sexo en el lapso del 13 al 26 de noviembre de 1983. Se conocieron 218 casos de paludismo, de los cuales 60 por ciento fueron infecciones por Plasmodium vivax el resto po P. falciparum. Los grupos de 10 a 14 años del sexo femenino y el de 15 a 44 años del sexo masculino se identificaron como los de mayor frecuencia. La frecuencia encontrada fue 63 veces mayor que la del Estado. Los hallazgos permitieron aplicar medidas oportunas para disminuir el riesgo de diseminación de las infecciones maláricas y lograr el control de este problema de salud pública

Leiomiosarcoma de pared abdominal. Reporte de un caso / Leiomyosarcoma of the abdominal wall. Report of a case

Se presenta un caso de leiomiosarcoma de pared abdominal en paciente de 25 años, del sexo femenino; la tumoración recidivó, en dos acaciones, posteriores a extirpación quirúrgica. En los estudios histológicos realizados hubo confusión diagnóstica: el primero reportó sarcoma sonovial y el segundo, rabdomiosarcoma de pared abdominal. La paciente se reintervino por presentar sintomatología colónica y el estudio histopatólogico diagnosticó leiomiosarcoma de lato grado de malignidad. La paciente se sometió a radioterapia y actualmente se encuentra casi asintomática .

Conocimientos y práctaca contraceptiva en obreros de un complejo agroindustrial / Understanding and contraceptive practice in workers from an agoindustrial complex

Se encuestaron 200 trabajadores del complejo agroindustrial "Patria o Muerte" para conocer su nivel de información sobre los métodos contraceptivos. El condón fue el contraceptivo más conocido, les siguieron en orden decreciente de frecuencia las tabletas anticonceptivas, los dispositivos intrauterinos y la esterilización quirúrgica; más del 70 por ciento de los encuestados tienen dominio de cada uno de ellos. Estos métodos a su vez fueron los más usados, los demás resultaron preferidos por menos del 3 por ciento de los hombres. De existir anticonceptivos orales o inyectables para el sexo masculino, el 52 por ciento de ellos estuvieron dispuestos a usarlos. La fuente principal para obtener conocimientos sobre contracepción fue la programación brindada por los medios masivos de difusión, seguida de la vía de comunicación con familiares o amigos y, por último, la información recibidadel personal de salud