Gastrointestinal Cytomegalovirus Infection in a Transplantation Recipient With a Negative Serum Viral Load: Case Report.

BACKGROUND: Kidney transplant recipients are vulnerable to infections, especially cytomegalovirus (CMV) disease. It is recommended that clinicians plan their prophylaxis and therapeutic regimens based on viral load testing. OBJECTIVE: CMV viral load monitoring testing provides useful information for identifying virologic response and possible antiviral resistance. Due to the paucity of medical literature on guiding viral therapy in cases of CMV tissue disease with nondetectable serum viral load, we intend to provide physicians with evidence on how to guide medical therapy in these cases. CASE REPORT: A 49-year-old Hispanic male recipient of a kidney transplant from a cadaver donor presented to the emergency department with anorexia, asthenia, diarrhea, weight loss, and supraclavicular and mediastinal adenomegalies at 2 months post-transplantation. Both patients were serum IgG- and IgM-positive for CMV, which classified them as intermediate risk for developing CMV disease or tissue-invasive disease (donor-positive/recipient-positive [D+/R+]). The patient was induced with basiliximab and methylprednisolone and received maintenance therapy with tacrolimus, mycophenolic acid, and prednisone. Real-time polymerase chain reaction analyses were performed due to suspicion for BK virus, B19 parvovirus, Epstein-Barr virus, and CMV, with an undetectable viral load for all. A biopsy specimen taken from the gastrointestinal tract confirmed CMV infection, which was corroborated through immunocytochemistry. CONCLUSIONS: Histopathologic testing is a possible option for patients with CMV tissue disease symptoms but no detectable serum viral load. Clinical observation is fundamental when viral monitoring is difficult.

Annular pancreas as a cause of neonatal duodenal obstruction, a case report.

The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some genetic component has been found in the etiology. A newborn full-term male, weighing at 1910 g at birth, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. Duodenal membrane is suspected after persistent postprandial vomiting and abdominal distension; his abdomen was distended, hyperresonant and soft. The gastroduodenal series showed data compatible with a duodenal membrane so exploratory laparotomy was performed, finding the pancreas completely wrapping the second portion of the duodenum, so a diamond-shaped-duodenoduodenostomy anastomosis was performed. The AP should be considered, especially in male neonates with postprandial vomiting, abdominal distension, who show some other congenital anomaly, and in the abdominal X-ray, the sign of the double bubble is observed.

Graft survival after kidney transplantation with standard versus prolonged kidney procurement time.

BACKGROUND: During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and thoracic organs, which may lead to poorer outcomes. The purpose of this study was to evaluate the impact of prolonged kidney procurement time (PKP) on outcomes of kidney transplantation performed at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. METHODS: We retrospectively reviewed the cases of all adult (age ≥ 18 yr) patients who underwent kidney transplantation at the Queen Elizabeth II Health Sciences Centre between Jan. 1, 2010, and Dec. 31, 2015. We included all patients who received kidney transplants from deceased donors with a minimum follow-up period of 3 years. We defined PKP as more than 65 minutes from aortic cross-clamp to final organ extraction, and standard procurement time (SP) as 65 minutes or less. RESULTS: Among the 455 transplantation procedures performed during the study period, we reviewed the cases of 145 patients who received kidneys from Nova Scotian donors and were followed in Nova Scotia. No statistically significant differences were seen in outcomes between kidney-only (n = 46) and multiorgan (n = 99) procurement, although more organs from kidney-only donors than multiorgan donors had a Kidney Donor Profile Index score greater than 50% (32 [69.6%] v. 48 [48.5%], p < 0.01). Compared to the SP group (n = 115), the PKP group (n = 30) had a higher rate of 30-day graft loss (6.7% v. 0.0%, p < 0.01), a higher incidence of de novo formation of donor-specific antibodies (3 [10.0%] v. 1 [0.9%], p < 0.01) and a lower 5-year graft survival rate (90.0% v. 97.4%, p = 0.03). Left kidneys remained 11 minutes longer on the donor than right kidneys when multiorgan procurement was performed (p < 0.01), and their 5-year survival rate was significantly lower than that of right kidneys (p = 0.03). CONCLUSION: Procurement times longer than 65 minutes may be associated with poorer outcomes after kidney transplantation. Measures to reduce kidney exposure to rewarming during procurement may improve long-term outcomes.

5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury.

BACKGROUND: Penetrating neck injuries represent 5-10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. METHODS: This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. RESULTS: A total of 70 neck exploration cases were reviewed, 34 (49%) didn't had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. CONCLUSIONS: Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided.

Complications and treatment to liver wound by gunshot. A retrospective approach.

INTRODUCCIÓN: Un trauma penetrante puede dañar una variedad de órganos. Dado que el hígado es un órgano sólido inelástico, no tiene la tolerancia al estiramiento necesaria para hacer frente a una herida por proyectil de arma de fuego (GSW). MÉTODOS: Este fue un estudio retrospectivo, observacional y descriptivo de 53 registros clínicos de pacientes ingresados en el Departamento de Cirugía por trauma hepático (LT) por un GSW. RESULTADOS: Del total de historias clínicas analizadas, el 89% de los pacientes presentaron una lesión asociada con LT. La lesión orgánica asociada más frecuente fue la torácica, específicamente la lesión pulmonar, en el 58%. El predictor más importante de mortalidad fue una estancia en la unidad de cuidados intensivos (UCI), que aumentó el riesgo unas 21 veces. CONCLUSIÓN: Una estadía en la UCI, seguida de la presencia de fracturas, fue el predictor más importante de mortalidad. Se necesitan nuevas medidas de pronóstico para contrarrestar las variables que ha creado el aumento de GSW, además de disminuir el tiempo de espera desde el evento traumático hasta el tratamiento relevante. INTRODUCTION: A penetrating trauma can damage a variety of organs. Since the liver is an inelastic solid organ, it does not have the necessary stretch tolerance to cope with a gunshot wound (GSW). METHODS: This was a retrospective, observational, and descriptive study of 53 clinical records of patients admitted to the Department of Surgery for liver trauma (LT) by a GSW. RESULTS: Of the total clinical records analyzed, 89% of the patients presented a lesion associated with LT. The most common associated organic lesion was thoracic, specifically lung injury, in 58%. The most important predictor of mortality was a stay in the intensive care unit (ICU), which increased the risk about 21 times. CONCLUSION: A stay in the ICU, followed by the presence of fractures, was the most important predictor of mortality. New prognostic measures are needed to counteract the variables that the increase in GSWs has created, in addition to decreasing the waiting time from the traumatic event to relevant treatment.

Presentation, management and evolution of patients with abdominal gunshot wound. A decade of violence in Mexico.

BACKGROUND: Traumatic injuries represent 9.6% of the global surface of the disease and represent the third most common cause of death in adults and adolescents. Patients were admitted to the hospital presenting traumatic injuries, penetrating abdominal traumatism remains a major cause of morbidity and mortality. OBJECTIVE: To analyze the presentation, handling and development of patient's gunshot wound. METHOD: Retrospective, descriptive, observational study. It was reviewed from 2010-2015 in the statistics department of the University Hospital Dr. José E. González all patients diagnosed with firearm projectile injury in abdomen. RESULTS: Were admitted above an average of 1.22 ± 0.51 lesions, on a Glasgow coma scale of 13.59 ± 2.5, oxygen saturation of 96.2 ± 2.09, heart rate of 94.4 ± 20, respiratory rate of 22 ± 6 and shock degree of 1.5 ± 0.80. CONCLUSION: Vital signs and specific characteristics of the lesion are essential and useful for the prediction of mortality due to abdominal traumatism by firearm projectile, in addition to the quantification of wounds and associated organic lesions, these are being evaluated both as a whole and separately.

ANTECEDENTES: Las lesiones traumáticas representan el 9.6% de la carga global de la enfermedad y son la tercera causa más común de muerte en adultos y adolescentes. Entre los pacientes ingresados en el hospital con lesiones traumáticas, el traumatismo penetrante abdominal sigue siendo una importante causa de morbilidad y mortalidad. OBJETIVO: Analizar la presentación, el manejo y la evolución de los pacientes con herida por proyectil de arma de fuego en el abdomen. MÉTODO: Estudio retrospectivo, descriptivo y observacional. Se revisaron todos los pacientes con diagnóstico de herida por proyectil de arma de fuego en el abdomen en el departamento de estadística del Hospital Universitario Dr. José E. González durante los años 2010-2015. RESULTADOS: Del total, 21 (9.1%) pacientes eran del sexo femenino y 229 (90.9%) del sexo masculino. Se ingresaron con un promedio de 1.22 ± 0.51 lesiones, con una puntuación en la Escala de coma de Glasgow de 13.59 ± 2.5, saturación de oxígeno de 96.2 ± 2.09, frecuencia cardiaca de 94.4 ± 20, frecuencia respiratoria de 22 ± 6 y grado de choque de 1.5 ± 0.80. CONCLUSIÓN: Los signos vitales y las características específicas de la lesión son esenciales y útiles para la predicción de la mortalidad por traumatismo abdominal por proyectil de arma de fuego, además de la cuantificación de heridas y lesiones orgánicas asociadas, siendo evaluadas estas tanto en un todo como por separado.

Prognosis of mortality and evolution in pancreatoduodenal trauma in patients with wound by projectile of firearm.

BACKGROUND: The wounds caused by the firearm projectile are published to date in a public health problem in the world. As an example, we mentioned the injuries caused by firearms are the first cause of death in the age group between 1 to 19 years in the United States, as in Mexico. OBJECTIVE: Analysis of the prognostic factors of mortality and evaluation of the evolution in patients with TPD due to abdominal HPPAF. METHOD: Retrospective, observational, descriptive study. Helped by 49 clinical files of patients who were admitted to the department of surgery of the University Hospital José Eleuterio González, between 2011 to 2015 and whose diagnosis was due to pancreatic trauma (TP), duodenal trauma (TD) or pancreatoduodenal trauma (TPD) by wounds caused by the firearm projectile. RESULTS: During a collection period of 5 years, a total of 49 clinical records applicable to the study were obtained according to the inclusion criteria, of which 36 (73%) suffered only from TD, 37 (75%) from TP and 24 (49%) about TPD. Significant differences were obtained for mortality associated with TD and TPD, but not for TP. The most affected organ as a lesion associated with a TPD was the liver, followed by thoracic structures and the stomach. The most significant risk factor for mortality was a prolonged stay in the intensive care unit. CONCLUSIONS: Data obtained are consistent with those consulted, providing new reproducible statistics for future studies regarding the increasing violence in our country and around the world.

ANTECEDENTES: Las heridas por proyectil de arma de fuego constituyen un problema de salud pública en el mundo. Como ejemplo mencionamos que este tipo de lesiones son la primera causa de muerte en el grupo de edad de 1 a 19 años en los EE.UU., al igual que en México. OBJETIVO: Análisis de los factores pronósticos de mortalidad y evaluación de la evolución en pacientes con TPD por HPPAF abdominal. MÉTODO: Estudio retrospectivo, observacional y descriptivo, realizado con 49 expedientes clínicos de pacientes que fueron admitidos en el departamento de cirugía del Hospital Universitario José Eleuterio González entre los años 2011 y 2015, cuyo diagnostico fue herida por proyectil de arma de fuego con trauma pancreático (TP), duodenal (TD) o pancreatoduodenal (TPD). RESULTADOS: Durante un periodo de recolección de 5 años se obtuvieron 49 expedientes clínicos aplicables al estudio según los criterios de inclusión, de los cuales 36 pacientes (73%) sufrieron únicamente TD, 37 (75%) TP y 24 (49%) TPD. Se obtuvieron diferencias significativas para la mortalidad asociada a TD y TPD, pero no para TP. El órgano más afectado como lesión asociada a un TPD fue el hígado, seguido de las estructuras torácicas y el estómago. El factor de riesgo para mortalidad más significativo fue una estancia prolongada en la unidad de cuidados intensivos. CONCLUSIONES: Los datos conseguidos concuerdan con los consultados, otorgando nueva estadística reproducible para futuros estudios respecto a la violencia creciente en nuestro país y alrededor del mundo.

Prognostic factors for survival and surgical complications in Whipple's pancreatoduodenectomy during a 10-year experience.

BACKGROUND: Periampullary neoplasms account for over 30,000 cancer-related deaths per year in the United States. Pancreaticoduodenectomy (PD) is considered the surgical standard and is the only curative treatment option for these pathologies. OBJECTIVE: The objective of this study was to report the prognostic factors in survival and surgical complications in PD. MATERIALS AND METHODS: A total of 178 cases are reported, several variables were reviewed and the same surgical technique was used by the same surgeon. RESULTS: A total of 151 PD were reviewed. The most common initial symptoms were jaundice, 111 (73%), abdominal pain, 20 (13%), and oral intolerance, 10 (6%). Poor prognostic factors for survival were the presence of a previous pathology, days of hospitalization, positive margins, and weight loss. DISCUSSION: With the experience gained, a decrease in surgical time, intraoperative bleeding, and transfusions performed was achieved. Our complication rate remained at 20%, lower than that reported in literature. CONCLUSION: PD is the only option of cure for patients with pancreatic and periampullary tumors. This procedure has been linked to high morbidity and mortality even in high-volume centers. A pancreatic fistula is the most feared complication; therefore, multiple pancreatojejunostomy techniques have been described in literature. It is important to continue reporting these cases to reach a consensus on this technique.

ANTECEDENTES: Las neoplasias periampulares suponen más de 30.000 muertes relacionadas con el cáncer por año en los EE.UU. La pancreaticoduodenectomía (PD) se considera el estándar quirúrgico y es la única opción de tratamiento curativo para esta enfermedad. OBJETIVO: Reportar los factores de pronóstico en la supervivencia y las complicaciones quirúrgicas de la PD. ­. MÉTODO: Se reportaron 178 casos; se revisaron varias variables y se utilizó la misma técnica quirúrgica por el mismo cirujano. RESULTADOS: Se revisaron 151 DP. Los síntomas iniciales más comunes fueron ictericia (111; 73%), dolor abdominal (20; 13%) e intolerancia oral (10; 6%). Los factores de pronóstico para la supervivencia fueron la presencia de patología previa, los días de hospitalización, los márgenes positivos y la pérdida de peso. DISCUSIÓN: Con la experiencia adquirida, se logró una disminución del tiempo quirúrgico, del sangrado intraoperatorio y de las transfusiones realizadas. Nuestra tasa de complicaciones se mantuvo en un 20%, inferior a la reportada en la literatura. CONCLUSIÓN: La PD es la única opción de curación para los pacientes con tumores pancreáticos y periampulares. Este procedimiento se ha relacionado con una alta morbilidad y mortalidad incluso en centros de alto volumen. La fístula pancreática es la complicación más temida, por lo que se han descrito numerosas técnicas de pancreatoyeyunostomía. Es importante seguir informando de estos casos para llegar a un consenso sobre esta técnica.

Apendagitis epiplóica primaria / Primary epiploic appendagitis

La apendagitis epiploica primaria es una rara causa de dolor abdominal que puede simular cualquier otro cuadro de abdomen agudo. Esto hace de su diagnóstico un verdadero desafío. Se presenta el caso de un paciente masculino de 22 años de edad, sin antecedentes de importancia que ingresó a la sala de emergencias con un cuadro de dolor abdominal de 36 horas de evolución. En la exploración física presentó dolor a la palpación en el flanco derecho. Se le realizó una tomografía axial de abdomen contrastada en la cual se observó una imagen redondeada con un halo hiperdenso con borramiento de planos grasos y cambios inflamatorios a su alrededor sin relación a otro órgano abdominal. Con estos hallazgos hicimos el diagnóstico de una apendagitis epiploica primaria. El paciente fue ingresado a la sala de internamiento para manejo del dolor y con mejoría clínica es egresado a las 48 horas asintomático. Si bien la apendagitis epiploica primaria es una causa infrecuente de dolor abdominal, consideramos que su conocimiento es relevante para evitar errores diagnósticos y terapéuticos que incrementan de forma innecesaria la morbilidad como el uso inadecuado de antibióticos y de recursos hospitalarios(AU)

Primary epiploic appendagitis is a rare cause of abdominal pain that may mimic any other acute abdomen condition. This makes its diagnosis a real challenge for physicians. Here is a 22 years-old male patient, with no significant history of diseases, who were admitted to the emergency room because he had suffered abdominal pain for 36 hours. The physical exam revealed pain on palpating the right flank. He underwent a contrasted computed tomography of abdomen which showed a rounded image with hyperdense halo, fat plane effacement and inflammatory changes around, which was unrelated to another abdominal organ. These findings allowed diagnosing primary epiploic appendagitis. The patient was hospitalized for pain management and was discharged 48 hours later with clinical improvement and no symptoms. Primary epiploic appendagitis is infrequent cause of abdominal pain, however, we consider that it is important to know it so as to avoid diagnostic and therapeutic mistakes that might unnecessarily increase morbidity and the inadequate use of antibiotics and of hospital resources(AU)

Apendagitis epiplóica primaria / Primary epiploic appendagitis

RESUMEN La apendagitis epiploica primaria es una rara causa de dolor abdominal que puede simular cualquier otro cuadro de abdomen agudo. Esto hace de su diagnóstico un verdadero desafío. Se presenta el caso de un paciente masculino de 22 años de edad, sin antecedentes de importancia que ingresó a la sala de emergencias con un cuadro de dolor abdominal de 36 horas de evolución. En la exploración física presentó dolor a la palpación en el flanco derecho. Se le realizó una tomografía axial de abdomen contrastada en la cual se observó una imagen redondeada con un halo hiperdenso con borramiento de planos grasos y cambios inflamatorios a su alrededor sin relación a otro órgano abdominal. Con estos hallazgos hicimos el diagnóstico de una apendagitis epiploica primaria. El paciente fue ingresado a la sala de internamiento para manejo del dolor y con mejoría clínica es egresado a las 48 horas asintomático. Si bien la apendagitis epiploica primaria es una causa infrecuente de dolor abdominal, consideramos que su conocimiento es relevante para evitar errores diagnósticos y terapéuticos que incrementan de forma innecesaria la morbilidad como el uso inadecuado de antibióticos y de recursos hospitalarios(AU)

ABSTRACT Primary epiploic appendagitis is a rare cause of abdominal pain that may mimic any other acute abdomen condition. This makes its diagnosis a real challenge for physicians. Here is a 22 years-old male patient, with no significant history of diseases, who were admitted to the emergency room because he had suffered abdominal pain for 36 hours. The physical exam revealed pain on palpating the right flank. He underwent a contrasted computed tomography of abdomen which showed a rounded image with hyperdense halo, fat plane effacement and inflammatory changes around, which was unrelated to another abdominal organ. These findings allowed diagnosing primary epiploic appendagitis. The patient was hospitalized for pain management and was discharged 48 hours later with clinical improvement and no symptoms. Primary epiploic appendagitis is infrequent cause of abdominal pain, however, we consider that it is important to know it so as to avoid diagnostic and therapeutic mistakes that might unnecessarily increase morbidity and the inadequate use of antibiotics and of hospital resources(AU)

Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report.

Neonatal gastric perforation (NGP) may be spontaneous, secondary to necrotizing enterocolitis (NEC), or due to distal obstruction. A 27-week old premature male newborn presented with pneumoperitoneum. A single perforation of stomach was found at surgery. Primary repair and gastrostomy were performed. On fifth postoperative day, pneumoperitoneum was again detected. At reoperation, multiple gastric perforations of the greater curvature were found. Sleeve gastrectomy was performed. The patient responded well to the treatment.

[Incidence of bacteria from cultures of bile and gallbladder wall of laparoscopic cholecystectomy patients in the University Hospital "Dr. José Eleuterio González"]. / Identificación de flora bacteriana en cultivos de bilis y pared de vesícula biliar de pacientes sometidos a colecistectomía laparoscópica en el Hospital Universitario «Dr. José Eleuterio González¼.

BACKGROUND: Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is s common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence. MATERIAL AND METHODS: 183 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had their bile sent to bacteriology. RESULTS: Bactibilia was identified in 31.95% of the cultures of mild cholecystitis and in 35.71% for moderate (p<.0001). A total of 125 negative cultures were obtained (68.3) and 58 positive (31.69%) with a prevalence of enterobacteria group (43.10%) and Enterococcus (27.58). CONCLUSIONS: Comparing the groups according to severity there is a significant difference with regard to the presence of bactibilia, in addition to the bacterial groups cultivated. Fluoroquinolones and metronidazole is an option for the treatment of patients with the suspicion of bactibilia. The use of antibiotics is not justified in patients at low risk.

[Epidemiology of gunshot wounds in the University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León]. / Epidemiología de las lesiones por proyectil de arma de fuego en el Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León.

BACKGROUND: The incidence of deaths and injuries associated with gunshot wounds deserves special attention, mainly because of its repercussions on hospital resources and the diagnosis and treatment protocols. OBJECTIVE: To perform an analysis on the epidemiological factors associated with gunshot wounds. MATERIAL AND METHODS: An analysis was made of multiple variables of all patients diagnosed with gunshot wounds during the period between 2005 and 2015. RESULTS: A total of 605 cases were found, and an additional sub-group of 314 cases was obtained for a deeper analysis. The overall mortality rate was 7.9%. The main anatomical region was the abdomen, with 44%. A total of 324 laparotomies were performed, 124 incisions of the thoracic wall, and 72 vascular examinations. In the sub-group of 314 cases, a 16.9% and 42% of laparotomies and vascular examinations, respectably, were reported without evidence of injury to internal organs. DISCUSSION: Morbidity and mortality increases when 2 or more wounds are present with multiple organ injuries, in patients with multiple transfusions, or in those transferred to the intensive care unit. CONCLUSIONS: The incorporation of a physical evaluation format by all the departments involved is suggested for patients that are attended with gunshot wounds, in order to obtain more epidemiological information of these injuries for further studies.

Bloqueo laparoscópico de plano abdominal transverso versus guiado por ultrasonido para el manejo del dolor postoperatorio en pacientes de colecistectomía laparoscópica / Transversus abdominis laparoscopic plane block versus guided with ultrasound for the management of postoperative pain in patients with laparoscopic cholecystectomy

Antecedentes: La analgesia efectiva es parte esencial en el manejo postoperatorio. Existe la necesidad de brindar técnicas de anestesia regional para minimizar el uso de opioides, y proveer una alternativa a los bloqueos regionales. Existen 2 técnicas para el bloqueo del plano transverso abdominal: la guiada por ultrasonido (BUPTA) y la laparoscópica (BLPTA), sin que actualmente se demuestre de una forma clara la superioridad de alguna de estas en la colecistectomía laparoscópica. Objetivo: Investigar los beneficios del BLPTA comparado con el BUPTA y la analgesia convencional comúnmente utilizada en pacientes que son sometidos a colecistectomía laparoscópica. Material y métodos: Se seleccionaron 45 pacientes y se dividieron en 3 grupos: 14 controles, 12 BUPTA y 19 BLPTA. Resultados: Se relacionó un mayor tiempo quirúrgico para el BUPTA (92 min) contra el BLPTA (74 min) y las convencionales (70 min). El dolor postoperatorio con el BUPTA y el BLPTA resultó ser menor comparado con el grupo control. Sin embargo, no se encontró significación estadística entre los 3 grupos. No se reportaron complicaciones durante los procedimientos quirúrgicos. Discusión: Las principales ventajas del BLPTA son la colocación bajo visión directa, el menor tiempo de aplicación y una reducción del dolor postoperatorio, siendo su principal desventaja la curva de aprendizaje que requiere. Conclusiones: El BLPTA y el BUPTA son un procedimiento efectivo para la analgesia posquirúrgica en pacientes sometidos a colecistectomía laparoscópica en comparación con la analgesia intravenosa.

Background: The effectiveness of the analgesia is essential in the postoperative management, importance exists in finding regional anesthetic techniques in order to minimize the use of opioids and promote a better alternative to regional blocks. Two techniques exist for the abdominal plane block (APB), one guided by ultrasound (UB) and the laparoscopic (LB) approach no clear benefit exists from on or the other in laparoscopic cholecystectomy patients. Objective: Determine which method results with mayor benefits in postoperative pain. Material and methods: 45 patients were selected and divided in 3 groups, control, UB and LB. Results: Longer operating times (94 min) were found for the UB group, for the LB and control group similar times were found (74 and 70 min). Less postoperative pain was found in the APB groups compared to control, however this was not statistical significance. No complications were found in the procedures. Discussion: The main advantages of the LB is infiltration under direct vision, faster learning curve and better application times. Conclusions: Both APB showed to be effective methods in the management of postoperative pain in patients postoperated of laparoscopic cholecystectomy compared to intravenous analgesia.

Reparación laparoscópica de hernia de Morgagni en un adulto: reporte de caso / Laparoscopic repair of hernia of Morgagni in adult life: case report

Antecedentes: La hernia de Morgagni (HM) es una anomalía rara que constituye el 2-5% de las todas las hernias diafragmáticas, siendo rara su evolución hasta la edad adulta. Caso clínico: Paciente masculino de 34 años que padece durante 3 años cuadros de mareos, diaforesis y disnea de leve a intermitente. En examen físico se ausculta hemitórax derecho hipoventilado. Se le realiza telerradiografía de tórax y tomografía axial computada (TAC), realizando diagnóstico de HM. Se repara quirúrgicamente mediante abordaje laparoscópico exitoso. Discusión: La HM corresponde a un defecto congénito de la cara anteromedial del diafragma, cuya presentación es infrecuente en el adulto. Comprende menos del 5% de las hernias diafragmáticas congénitas. Conclusión: Este reporte de caso confirma el concepto de la literatura sobre las ventajas conocidas del tratamiento laparoscópico de esta rara patología.

Background: Morgagni hernia (MH) is a rare anomaly that constitutes 2-5% of all diaphragmatic hernias, the evolution until adult life is rare. Clinical case: 34 year old patient who referred 3 years with mild effort dyspnea. During physical exploration right hemithorax was found with hypoventilated. Chest x-ray showed right diaphragmatic herniation. Computer tomography (CT) diagnosed Morgagni herniation. The patient was programmed for laparoscopic repair with double layer mesh and it was fixated with tackers. Discussion: Morgagni herniation corresponds to a genetical defect in the anteromedial diaphragm, this presentation is rare in adults. It represents 5% of congenital hernias. Conclusion: Laparoscopic repair takes much less time to operate, faster recovery time and less postsurgical pain with short hospital stay.

Fibrosis mediastinal, una causa poco frecuente de quilotórax bilateral: Reporte de caso / Mediastinal Fibrosis. A rare cause of bilateral chylothorax. Case Report

Antecedentes: La presencia de quilotórax se define como un líquido pleural con abundantes concentraciones de quilomicrones, o con niveles elevados de triglicéridos, mayor a 110 mg/dl y bajos de colesterol. Dentro de las causas más frecuentes de quilotórax no traumático o secundario a un abordaje quirúrgico tenemos las neoplasias hematológicas y tumoraciones mediastinales. Objetivo: Reportar el éxito de ésta opción terapéutica ofrecida. Caso clínico: Paciente femenino de 58 años con antecedente de 1 año de evolución con dolor lumbar. La tomografía reporta tumoración mediastinal con derrame pleural bilateral. Se realiza toracocentésis obteniendo calidad del liquido como quilotórax bilateral. Se inicia manejo medico y se procede a realizar toracotomía izquierda y toracoscopía derecha con pleurodesis química con iodopovidona. La paciente evoluciona favorablemente, dependiente de oxígeno. Los resultados finales de patología reportan mediastinitis fibrosante IgG4 negativo. Discusión: Los síntomas de presentación de la enfermedad son poco específicos y depende de la afectación de órganos torácicos. En nuestro caso se trató de afectación del conducto torácico, con la consecuente formación de quilotórax bilateral. Conclusiones: No existe un tratamiento curativo definitivo para esta enfermedad. La mortalidad es variable, reportándose de hasta 30% a 6 años y esta relacionada a la afectación de los órganos intratorácicos.

Background: The prescience of chylothorax is defined as pleural liquid with abundant concentrations of chylomicrons, with high levels of triglycerides, more than 110 mg/dl and low in cholesterol. Between the most frequent causes of non-traumatic chylothorax are secondary to a surgical procedure, hematologic neoplasms and mediastinal tumors. Objective: Report de success rate of the therapeutic technique used in this patient. Clinical Case: A 48-year-old female with history of 1 year of lumbar pain, a computer tomography was performed where mediastinal tumor and bilateral pleural effusion was diagnosed. A thoracentesis was performed diagnosing bilateral chylothorax. Medical treatment was started without improvement, a left thoracotomy and right thoracoscopy with chemical pleurodesis were performed. Patient improved clinically, dependent of oxygen. Final pathologic exam reported IgG4 negative fibrosant mediastinitis. Discussion: The symptoms of presentation of the disease are not specific and depend on the invasion to adjacent thoracic organs, with the consequent formation of bilateral chylothorax. Conclusions: No curative treatment exists for this disease. It presents with variable mortality, some of 30% at 6 years and it is related with intrathoracic organ affection.

Evaluación del estado nutricional y su impacto en pacientes post operados de anastomosis intestinal. Nutrición y fuga anastomosis / Evaluation of nutritional status and its impact in postoperated patients of intestinal anastomosis. Nutrition and anastomotic leak

Antecedentes: La prevalencia de la desnutrición entre los pacientes quirúrgicos es elevada y se ha relacionado con el aumento de la morbimortalidad. La fuga de anastomosis es una de las complicaciones quirúrgicas más importantes y se ha relacionado con desnutrición, mala técnica quirúrgica, contaminación abdominal entre otras. Objetivo: Demostrar que la relación de la desnutrición y la incidencia de dehiscencia de anastomosis en pacientes post operados. Material y Métodos: Se evaluara por medio del cuestionario de Valoración Global Subjetiva el estado nutricional de pacientes sometidos a intervenciones quirúrgicas abdominales que requieran resección y anastomosis. Se incluyeron 34 pacientes en este estudio de investigación, dividiendo los grupos en bien nutridos y malnutridos. Resultados: Se concluyó que Existe una mayor prevalencia en el grupo malnutrido de dehiscencia de anastomosis 11.8% en comparación al grupo bien nutrido 5.9% sin embargo no fue estadísticamente significativo (p=>0.05). Discusión: El grupo mal nutrido presentaba una media en edad mayor que el grupo bien nutrido, el IMC, la albumina y la cuenta linfocitaria eran menores en el grupo mal nutrido en comparación al bien nutrido. Conclusiones: Se realizo el análisis de las variables con la prueba Chi cuadrada en la cual no se encontró asociación entre las variables estudiadas (AU)

Background: The prevalence of malnutrition between surgical patients is high and it is related with an increase in morbility and mortality. Anastomotic leak is one of the most important surgical complications and it is related with the surgeon’s technique, malnutrition and abdominal contamination. Objective: To prove the relationship between malnutrition and the incidence of anastomotic leak in postoperated patients. Material and Methods: Patients will be evaluated through the global subjective evaluation in the nutritional status they belong and then the intestinal resection and anastomosis will be performed. 34 patients were included, divided in good and poor nutrition groups. Results: A prevalence of anastomotic leak in the poor nutrition group was of 11.8%, and the good nutrition group of 5.9%. Discussion: The poor nutrition group had an average age higher than the good nutrition group. The IMC, albumin, leucocyte count were inferior in the poor nutrition group. Conclusions: Variable analysis with square Chi found no evidence of statistical significance between the studied groups (AU)