Experiencia de uso de hierro intravenoso para el tratamiento de la anemia en niños y adolescentes. Respuesta terapéutica y evolución / Experience in using intravenous iron for the treatment of anemia in children and adolescents. Therapeutic response and evolution

Introducción: El hierro de administración intravenosa (iv) está indicado en los casos en que el tratamiento oral no es posible. El objetivo de este trabajo fue describir el perfil de uso, respuesta terapéutica y seguridad de la administración de hierro iv en el tratamiento de la anemia ferropénica en niños, niñas y adolescentes (NNA) asistidos en un centro de referencia de Uruguay entre 2018 y 2023. Método: Estudio retrospectivo mediante revisión de historias. Incluyó todos los NNA que recibieron hierro iv. Se registraron variables sociodemográficas, comorbilidades, clínica y severidad de la anemia. Se evaluó: motivos de la indicación y tipo de hierro iv, dosis, tiempo de infusión, respuesta terapéutica y efectos adversos. Resultados: Se incluyeron 35 pacientes, mediana de edad 4 años; 51,4% de sexo masculino, con comorbilidades 37,1%. Todos los menores de 3 años presentaban factores de riesgo para anemia ferropénica, la falta de adherencia al hierro oral se asoció con mayor severidad de la anemia (p<0,05). El motivo principal de indicación de hierro iv fue la severidad de la anemia e inadecuada respuesta al hierro oral concomitante en 37,1%. Todos recibieron hierro sacarato; mediana de dosis: 2 mg/kg y de tiempo de infusión: 1 hora. Se registró un caso de edema y exantema de cara vinculado a la rápida infusión. La evolución fue satisfactoria. Conclusiones: La administración de hierro iv fue segura. Es necesario establecer consensos respecto a la posología y monitorización. Se requieren nuevos estudios para continuar evaluando la eficacia y seguridad del hierro iv en sus diversas formulaciones.

Introduction: Intravenous (IV) iron administration it is indicated in cases where oral treatment is impossible. The objective of this work was to describe the profile of use, therapeutic response, and safety of the iron IV administration in treating anemia in children and adolescents (NNA) assisted in a reference center in Uruguay between 2018 and 2023. Method: Retrospective study through review of histories. It included all children and adolescents who received IV iron. Sociodemographic variables, comorbidities, clinical symptoms, and severity of anemia they were recorded. They were evaluated: reasons for the indication and type of IV iron, dose, infusion time, therapeutic response, and adverse effects. Results: we included 35 patients, with a median age of four years; 51.4% were male, and 37.1% had comorbidities. All children under three years of age had risk factors for iron deficiency anemia; greater severity of anemia was associated with lack of adherence to oral iron (p<0.05). The main reason for the indication of IV iron was the severity of anemia and inadequate response to concomitant oral iron at 37.1%. All received iron saccharate; median dose: 2 mg/kg and infusion time: 1 hour. A case of facial edema and rash linked to rapid infusion was recorded. The evolution was satisfactory. Conclusions: The administration of IV iron was safe. It is necessary to establish a consensus regarding dosage and monitoring. New studies are required to continue evaluating the efficacy and safety of IV iron in its various formulations.

Adipose derived stromal vascular fraction and fat graft for treating the hands of patients with systemic sclerosis. A randomized clinical trial.

BACKGROUND: Systemic Sclerosis in the hand is characteristically evidenced by Raynaud's phenomenon, fibrosis of the skin, tendons, ligaments, and joints as well as digital ulcers with prolonged healing. Current medical treatment does not always cure these complications. Local adipose-derived stromal vascular fraction administration into the hands has been proposed as an emerging treatment due to its regenerative properties. The objective of this randomized controlled clinical trial was to evaluate the safety and clinical effects of fat micrografts plus adipose derived-stromal vascular fraction administration into the hands of patients with systemic sclerosis. METHODS: This was an open-label, monocentric, randomized controlled study. Twenty patients diagnosed with systemic sclerosis were assigned to the experimental or control group. Fat micrografts plus the adipose derived-stromal vascular fraction were injected into the right hand of experimental group patients. The control group continued to receive only medical treatment. Demographic, serologic data and disease severity were recorded. Digital oximetry, pain, Raynaud phenomenon, digital ulcers number, mobility, thumb opposition, vascular density of the nail bed, skin affection of the hand, serologic antibodies, hand function, and quality of life scores were evaluated in both groups. RESULTS: The results of the intervention were analyzed with the Wilcoxon rank test, and the differences between the control and experimental groups at 0 days and 168 days were analyzed with the Mann-Whitney U test. Adverse events were not observed in both groups. At the end of the study, statistically significant improvements were observed in pain levels (p<0.05) and number of digital ulcers (p<0.01) in the experimental vs control group. CONCLUSION: The injection of adipose derived-stromal vascular fraction plus fat micrografts is a reproducible, and safe technique. Pain and digital ulcers in the hands of patients with systemic sclerosis can be treated with this technique plus conventional medical treatment.

Proteomic analysis and optimized production of Alkalihalobacillus patagoniensis PAT 05T extracellular proteases.

Extracellular proteolytic extracts from the haloalkalitolerant strain Alkalihalobacillus patagoniensis PAT 05T have proved highly efficient to reduce wool felting, as part of an ecofriendly treatment suitable for organic wool. In the present study, we identified the extracellular proteases produced by PAT 05T and we optimized its growth conditions for protease production through statistical methods. A total of 191 proteins were identified in PAT 05T culture supernatants through mass spectrometry analysis. Three of the 6 detected extracellular proteases belonged to the serine-endopeptidase family S8 (EC 3.4.21); two of them showed 86.3 and 67.9% identity with an alkaline protease from Bacillus alcalophilus and another one showed 50.4% identity with Bacillopeptidase F. The other 3 proteases exhibited 55.3, 49.4 and 61.1% identity with D-alanyl-D-alanine carboxypeptidase DacF, D-alanyl-D-alanine carboxypeptidase DacC and endopeptidase LytE, respectively. Using a Fractional Factorial Design followed by a Central Composite Design optimization, a twofold increase in protease production was reached. NaCl concentration was the most influential factor on protease production. The usefulness of PAT 05T extracellular proteolytic extracts to reduce wool felting was possible associated with the activity of the serine-endopeptidases closely related to highly alkaline keratinolytic proteases. The other identified proteases could cooperate, improving protein hydrolysis. This study provided valuable information for the exploitation of PAT 05T proteases which have potential for the valorization of organic wool as well as for other industrial applications.

Experiencia y manejo de dos pacientes pediátricos grandes quemados e infección por SARS-CoV-2 en una unidad de cuidados intensivos / Experience and management of two paediatric patients infected with SARS-CoV-2 with major burn injuries in an intensive care unit

RESUMEN La infección por SARS-CoV-2 se ha diseminado rápidamente, provocando una pandemia mundial en la cual nos vemos afectados. En el Instituto Nacional de Salud del Niño de San Borja, centro de referencia nacional de pacientes pediátricos quirúrgicos, desde el 14 de abril al 12 de agosto del 2020, se hospitalizaron 106 pacientes con infección por SARS-CoV-2, de los cuales 11 tuvieron diagnostico quemadura y dos fueron pacientes grandes quemados con diagnóstico COVID-19 por prueba molecular. Detallamos el caso de una paciente pediátrica, de siete años, gran quemada que fue atendida en unidad de cuidados intensivos, y con COVID-19 asintomática, presentó evolución y pronóstico favorable, con recuperación total de su lesión. Por otro lado, el COVID-19 se puede manifestar de forma severa produciendo un síndrome inflamatorio multisistémico que presenta manifestaciones clínicas poco comunes y que puede empeorar el pronóstico, como fue observado en nuestro otro paciente de siete meses que falleció pese a recibir manejo especializado y oportuno.

ABSTRACT SARS-CoV-2 infection is rapidly disseminating, leading to a world pandemics in which we are also affected. In San Borja Peruvian National Children Health Institute, which is the reference center for surgical pediatric patients, 106 patients infected with SARS-CoV-2 were hospitalized. Of them, 11 presented with burns and two had large burns. The viral infection was diagnosed using molecular testing. We present in detail the case of a pediatric seven-year old patient who had large burns and was taken care of in the intensive care unit. She had asymptomatic SARS-CoV-2 infection, and her outcome was good, with a good prognosis, and she recovered completely and uneventfully. On the other hand, COVID-19 may present as a severe disease leading to a multi- systemic inflammatory syndrome with some uncommon clinical manifestations which affect its prognosis , as it was the case with another seven-month old patient who passed away in spite of having received specialized and timely therapy.

Bilateral Proximal Forearm Transplantation: Case Report at 7 Years.

BACKGROUND: Although return of function has been reported in patients undergoing proximal forearm transplantations (PFTs), reports of long-term function are limited. In this study, we evaluated the clinical progress and function 7 years postoperatively in a patient who underwent bilateral PFT. CASE PRESENTATION: A 58-year-old man underwent bilateral PFT in May 2012. Transplantation involved all of the flexor and extensor muscles of the forearm. Neurorrhaphies of the median, ulnar, and radial nerves were epineural and 7 cm proximal to the elbow. Immunosuppressive maintenance medications during the first 3 years postoperatively were tacrolimus, mycophenolate, and steroids, and later, tacrolimus, sirolimus, and steroids. Forearm function was evaluated annually using the Disabilities of the Arm, Shoulder, and Hand; Carroll; Hand Transplantation Score System; Short Form-36; and Kapandji scales. We also evaluated his grip and pinch force. RESULTS: Postoperatively, the patient developed hypertriglyceridemia and systemic hypertension. He experienced 6 acute rejections, and none were resistant to steroids. Motor function findings in his right/left hand were: grip strength: 10/13 kg; key pinch: 3/3 kg; Kapandji score: 6/9 of 10; Carroll score: 66/80; Hand Transplantation Score System score: 90/94. His preoperative Disabilities of the Arm, Shoulder, and Hand score was 50 versus 18, postoperatively; his Short Form-36 score was 90. This function improved in relation with the function reported in the second year. CONCLUSIONS: Seven years following PFT, the patient gained limb strength with a functional elbow and wrist, although with diminished digital dexterity and sensation. Based on data presented by other programs and our own experience, PFT is indicated for select patients.

Decoupling between the hand territory and the default mode network after bilateral arm transplantation: four-year follow-up case study.

Several studies have suggested both a local and network reorganization of the sensorimotor system following amputation. Transplantation of a new limb results in a new shifting of cortical activity in the local territory of the transplanted limb. However, there is a lack of information about the reversibility of the abnormalities at the network level. The objective of this study was to characterize the functional connectivity changes between the cortical territory of the new hand and two intrinsic network of interest: the sensorimotor network (SMN) and the default mode network (DMN) of one patient whom received bilateral forearm transplants. Using resting-state fMRI these two networks were identified across four different time points, starting four months after the transplantation surgery and during three consecutive years while the patient underwent physical rehabilitation. The topology of the SMN was disrupted at the first acquisition and over the years returned to its canonical pattern. Analysis of the DMN showed the normal topology with no significant changes across acquisitions. Functional connectivity between the missing hand's cortical territory and the SMN increased over time. Accordingly, functional connectivity between the missing hand's cortical territory and the DMN became anticorrelated over time. Our results suggest that after transplantation a new reorganization occurs at the network level, supporting the idea that extreme behavioral changes can affect not only the local rewiring but also the intrinsic network organization in neurologically healthy subjects. Overall this study provides new insight on the complex dynamics of brain organization.

Newly isolated Bacillus sp. G51 from Patagonian wool produces an enzyme combination suitable for felt-resist treatments of organic wool.

Bacteria from Patagonian Merino wool were isolated to assess their wool-keratinolytic activity and potential for felt-resist treatments. Strains from Bacillus, Exiguobacterium, Deinococcus, and Micrococcus produced wool-degrading enzymes. Bacillus sp. G51 showed the highest wool-keratinolytic activity. LC-MS/MS analysis revealed that G51 secreted two serine proteases belonging to the peptidase family S8 (MEROPS) and a metalloprotease associated with Bacillolysin, along with other enzymes (γ-glutamyltranspeptidase and dihydrolipoyl dehydrogenases) that could be involved in reduction of keratin disulfide bonds. Optimum pH and temperature of G51 proteolytic activity were 9 and 60 °C, respectively. More than 80% of activity was retained in H2O2, Triton X-100, Tween 20, Lipocol OXO650, Teridol B, and ß-mercaptoethanol. Treatment of wool top with G51 enzyme extract caused a decrease in wool felting tendency without significant weight loss (<1.5%). Sparse work has so far been performed to investigate suitable keratinases for the organic wool sector. This eco-friendly treatment based on a new enzyme combination produced by a wild bacterium has potential for meeting the demands of organic wool processing which bans the use of hazardous chemicals and genetic engineering.

Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.

BACKGROUND: Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire. METHODS: We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012. RESULTS: At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes. CONCLUSIONS: Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.

Digital Reconstruction with a Nonfrozen Osteotendinous Allograft, Nerve Allografts, and Autogenous Radial Free Flap.

A 21-year-old man underwent amputation of his second to fifth fingers at the proximal phalanx level on the right hand. The third and fourth fingers were reconstructed with 2 toe-to-hand free transfers. The fifth digit was reconstructed with a nonfrozen osteotendinous allograft, nerve allografts, and autogenous radial free flap without immunosuppression. The patient was lost to follow-up for 19 years. He received no rehabilitation. He reported that he had experienced no adverse reactions to the materials or the graft, or infection, or fractures. No additional surgical procedures were performed. Today, the digit is functional and has acceptable aesthetic appearance. This outcome is similar to those obtained in digits reconstructed with frozen osteotendinous allografts and autologous cutaneous covers and opens the possibility for future research.

Soft tissue reconstruction with omental free flap in complex upper extremity injuries: report of 13 cases.

Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.

Técnica Portie IV en el tratamiento quirúrgico de la obesidad mórbida extrema / Portie IV technique in the surgical treatment of extreme morbid obesity

Introducción: se presenta una serie de 16 pacientes con obesidad mórbida extrema operados con la técnica Portie IV en el hospital universitario general Calixto García. Objetivo: exponer la técnica Portie IV y destacar el uso del método clínico en su concepción quirúrgica atendiendo a la recolección, evaluación y aplicación en su diseño del tipo de obesidad mórbida extrema y las comorbilidades de cada paciente. Métodos: entre febrero de 2007 y febrero de 2012, se realizaron 16 cirugía bariátrica metabólica en pacientes con obesidad mórbida extrema a todos se le aplicó la técnica quirúrgica de derivación gastrobiliopancreática Portie IV. Se recogieron las variables: edad, sexo, tipo de obesidad, comorbilidades mayores y menores, eventos perioperatorios y complicaciones. Los resultados de las variables analizadas se muestran en cifras absolutas, medias y porcentaje. Resultados: el sexo femenino predominó en una relación 2-1 con respecto al masculino y la obesidad tipo V (3-1) con respecto a la obesidad tipo IV, el grupo de edad más afectado de los pacientes fue el de entre 28 y 37 años de edad (50 por ciento). Dentro de la comorbilidades la hipertensión arterial, la dislipidemia y la apnea obstructiva del sueño estuvieron presentes en 100 por ciento de los casos. El tiempo quirúrgico promedio fue de 245 minutos. La complicación más frecuente fue el vómito en 4 pacientes de 16 (25 por ciento), mortalidad (6,2 por ciento), 1 paciente de 16. Conclusiones: los resultados obtenidos a corto, mediano y largo plazo en el tratamiento quirúrgico de la obesidad extrema con la técnica Portie IV han sido satisfactorios, seguros y efectivos en el cambio de sus estilos de vida(AU)

Introduction: a series of 16 patients with extreme morbid obesity, who were operated on with Portie IV technique in Calixto García general university hospital, was presented. Objectives: to present Portie IV technique and to underline the use of the clinical method in its surgical conception, taking into account the collection, evaluation and implementation in extreme morbid obesity and the comorbidities of each patient. Methods: from February 2007 through February 2012, sixteen bariatric metabolic surgeries were performed in patients with extreme morbid obesity; all of them were applied the Portie IV gastrobiliary pancreatic shunt surgical technique. The following variables were collected: age, sex, type of obesity, major and minor comorbidities, perioperative events and complications. The results of the analyzed variables were shown in absolute, mean and percentage figures. Results: females predominated in 2:1 ratio with respect to males, and type V obesity (3:1) with respect to type IV obesity, the most affected age group was 28-37 years-old (50 percent). Among the comorbidities, blood hypertension, dyslipidemia and obstructive apnea of the sleep were present in 100 percent of cases. The average surgical time was 245 minutes. The most frequent complication was vomiting in 4 (25 percent ) patients out of 16, mortality (6.2 percent ) representing one patient out of 16. Conclusions: the short, medium and long-term results of the surgical treatment of the extreme morbid obesity by using Portie IV technique have been satisfactory, safe and effective in their change of lifestyles(AU)

Técnica Portie IV en el tratamiento quirúrgico de la obesidad mórbida extrema / Portie IV technique in the surgical treatment of extreme morbid obesity

Introducción: se presenta una serie de 16 pacientes con obesidad mórbida extrema operados con la técnica Portie IV en el hospital universitario general Calixto García. Objetivo: exponer la técnica Portie IV y destacar el uso del método clínico en su concepción quirúrgica atendiendo a la recolección, evaluación y aplicación en su diseño del tipo de obesidad mórbida extrema y las comorbilidades de cada paciente. Métodos: entre febrero de 2007 y febrero de 2012, se realizaron 16 cirugía bariátrica metabólica en pacientes con obesidad mórbida extrema a todos se le aplicó la técnica quirúrgica de derivación gastrobiliopancreática Portie IV. Se recogieron las variables: edad, sexo, tipo de obesidad, comorbilidades mayores y menores, eventos perioperatorios y complicaciones. Los resultados de las variables analizadas se muestran en cifras absolutas, medias y porcentaje. Resultados: el sexo femenino predominó en una relación 2-1 con respecto al masculino y la obesidad tipo V (3-1) con respecto a la obesidad tipo IV, el grupo de edad más afectado de los pacientes fue el de entre 28 y 37 años de edad (50 por ciento). Dentro de la comorbilidades la hipertensión arterial, la dislipidemia y la apnea obstructiva del sueño estuvieron presentes en 100 por ciento de los casos. El tiempo quirúrgico promedio fue de 245 minutos. La complicación más frecuente fue el vómito en 4 pacientes de 16 (25 por ciento), mortalidad (6,2 por ciento), 1 paciente de 16. Conclusiones: los resultados obtenidos a corto, mediano y largo plazo en el tratamiento quirúrgico de la obesidad extrema con la técnica Portie IV han sido satisfactorios, seguros y efectivos en el cambio de sus estilos de vida(AU)

Introduction: a series of 16 patients with extreme morbid obesity, who were operated on with Portie IV technique in Calixto García general university hospital, was presented. Objectives: to present Portie IV technique and to underline the use of the clinical method in its surgical conception, taking into account the collection, evaluation and implementation in extreme morbid obesity and the comorbidities of each patient. Methods: from February 2007 through February 2012, sixteen bariatric metabolic surgeries were performed in patients with extreme morbid obesity; all of them were applied the Portie IV gastrobiliary pancreatic shunt surgical technique. The following variables were collected: age, sex, type of obesity, major and minor comorbidities, perioperative events and complications. The results of the analyzed variables were shown in absolute, mean and percentage figures. Results: females predominated in 2:1 ratio with respect to males, and type V obesity (3:1) with respect to type IV obesity, the most affected age group was 28-37 years-old (50 percent). Among the comorbidities, blood hypertension, dyslipidemia and obstructive apnea of the sleep were present in 100 percent of cases. The average surgical time was 245 minutes. The most frequent complication was vomiting in 4 (25 percent ) patients out of 16, mortality (6.2 percent ) representing one patient out of 16. Conclusions: the short, medium and long-term results of the surgical treatment of the extreme morbid obesity by using Portie IV technique have been satisfactory, safe and effective in their change of lifestyles(AU)

Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

BACKGROUND: Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. CLINICAL CASES: From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. CONCLUSIONS: Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the open harvesting technique, with the advantage of a smaller scar at the donor site. Based on the results, the authors consider the reported technique to be useful and valid. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Revascularization of Arterialized Venous Flaps through a Total Retrograde Reverse Blood Flow: Randomized Experimental Trial of Viability.

BACKGROUND: Arterialized venous flaps (AVFs) have been used for reconstruction of soft tissue defects throughout the body. Several different revascularization models have been performed, but venous drainage through the arterial system has not been studied. In our total retrograde reverse blood flow (TRRBF) perfusion model, the arterial blood flow enters through the venous system and venous drainage exits through the arterial system. METHODS: We developed a novel experimental model in rabbit ears to evaluate the capacity of TRRBF perfusion pattern to allow AVF viability. The ears were assigned to 3 groups: group 1, total devascularization without revascularization (n = 3); group 2, TRRBF (n = 12); and group 3, conventional AVF (n = 12). The ears were observed during a 30-day follow-up period, and clinical serial assessment of edema, cyanosis, and necrosis was performed. Tissue oxygenation was determined at the beginning and end of the follow-up. Histological analysis was performed. RESULTS: Necrosis was found in 3/3 (100%) ears in group 1, 3/12 (25%) in group 2, and 0/12 (0%) in group 3 (95% CI, 0.505-0.994; P = 0.0001). In group 2, edema was higher (5/12, 41.66%) than in group 3 (0/12, 0%) (95% CI, 0.0135-0.65; P = 0.041). Cyanosis and venous congestion was of greater intensity and duration in group 2 than in group 3 (10.33 ± 4.51 vs 4.5 ± 2.06 d). CONCLUSIONS: Although evolution is torpid and prolonged in ears with TRRBF, 9/12 (75%) survived, suggesting that TRRBF can be used as a rescue method.

Diverticulitis exclusiva de ciego / Unique diverticulitis of the cecum

La diverticulitis cecal es una rara entidad de difícil diagnóstico que con frecuencia se confunde con un proceso apendicular agudo. Los divertículos primarios o de origen congénito, generalmente son únicos, suelen presentarse en una edad más temprana que la enfermedad diverticular cólica (divertículos secundarios). La presencia de estos en el colon derecho se reporta con menor frecuencia, su diagnóstico es en muchas ocasiones indistinguible de la apendicitis aguda y se realiza en la mayoría de los casos durante la laparotomía, el tratamiento es variable, según la literatura abarca desde la resección del divertículo hasta la hemicolectomía derecha. El objetivo de esta presentación es referir la dificultad diagnostica y la alta frecuencia de error diagnóstico que presenta esta entidad(AU)

The cecal diverticulitis is a strange disease, difficult to be diagnosed, frequently confused with acute appendicular process. The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula). Their presence in the right colon is less frequently reported, the diagnosis is often confused with that of acute appendicitis and most of cases undergo laparatomy. According to the scientific literature, the treatment is variable, ranging from diverticular resection to right hemi-cholectomy. The objective of this paper was to present the difficulties and the high frequency of errors in diagnosing this disease(AU)

Diverticulitis exclusiva de ciego / Unique diverticulitis of the cecum

La diverticulitis cecal es una rara entidad de difícil diagnóstico que con frecuencia se confunde con un proceso apendicular agudo. Los divertículos primarios o de origen congénito, generalmente son únicos, suelen presentarse en una edad más temprana que la enfermedad diverticular cólica (divertículos secundarios). La presencia de estos en el colon derecho se reporta con menor frecuencia, su diagnóstico es en muchas ocasiones indistinguible de la apendicitis aguda y se realiza en la mayoría de los casos durante la laparotomía, el tratamiento es variable, según la literatura abarca desde la resección del divertículo hasta la hemicolectomía derecha. El objetivo de esta presentación es referir la dificultad diagnostica y la alta frecuencia de error diagnóstico que presenta esta entidad

The cecal diverticulitis is a strange disease, difficult to be diagnosed, frequently confused with acute appendicular process. The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula). Their presence in the right colon is less frequently reported, the diagnosis is often confused with that of acute appendicitis and most of cases undergo laparatomy. According to the scientific literature, the treatment is variable, ranging from diverticular resection to right hemi-cholectomy. The objective of this paper was to present the difficulties and the high frequency of errors in diagnosing this disease

Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country.

Few reports about body contouring surgery after massive weight loss (MWL) have been produced in the developing countries. As Mexico is considered a developing country, we performed a retrospective analysis of medical records of patients who underwent this type of surgery to evaluate their demographic characteristics as well as their outcomes and complications. Results from 684 patients with MWL, 69 (10%) had abdominoplasty; the type of abdominoplasty influenced the operative time, bleeding, and complications (P < 0.05); the body mass index influenced the weight of resected tissue (P < 0.000) and hospital stay (P < 0.020), but did not affect the type of abdominoplasty performed, surgical time, complications, reoperation, or transfusion rates. In contrast with the developed countries, in these procedures, operating time was higher and the patients had more surgical bleeding with higher rates of transfusion and a longer hospital stay, but with the same clinical results and percentage of complications.

An anthropometric classification of body contour deformities after massive weight loss.

Deformities caused by massive weight loss were originally subsidized at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán." This caused great economical losses, which led to the development of a classification to select patients with functional problems secondary to massive weight loss. The parameter used is the size of the pannus in relation to fixed anatomic structures within the following anatomic regions: abdomen, arms, thighs, mammary glands, lateral thoracic area, back, lumbar region, gluteal region, sacrum, and mons pubis. Grade 3 deformities are candidates for body contouring surgery because they constitute a functional problem. Grade 2 deformities reevaluated whether the patient has comorbidities. Lesser grades are considered aesthetic procedures and are not candidates for surgical rehabilitation at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán." This classification allowed an improvement in communication between the different surgical-medical specialties; therefore, we suggest its application not only for surgical-administrative reasons but also for academic purposes.