Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say?

Hernia repair is one of the most frequent interventions in surgery worldwide. The approach to abdominal wall and inguinal hernias remains a challenge due to emerging evidence on aspects such as timely diagnosis, use of innovative techniques or post-surgical care. However, pre-operative preparation is also a factor that substantially affects the absolute success rate of this type of condition. Time management between diagnosis and intervention, control of diseases that increase intra-abdominal pressure, weight and nutritional status, are some of the many elements to be considered in this type of patients before surgery. Considering that this condition carries high health care costs, especially in case of recurrence, has a risk of complications and affects the individual's functional capacity, the objective of this review is to synthesize evidence on the role of these factors on the short- and long-term outcome of inguinal hernia management, and to make suggestions on the general approach to this type of patients.

Osteosintesis de fracturas complejas de húmero distal. Nuestra experiencia / Osteosynthesis of complex fractures of the distal humerus. Our experience

Objetivo: Describir los resultados obtenidos en el tratamiento de las fracturas de húmero distal mediante reducción abierta y fijación interna y reflejar si el abordaje empleado tuvo impacto en el resultado funcional. Materiales y métodos: Se llevó a cabo un estudio retrospectivo de presentación de casos. Se evaluó a 19 pacientes con diagnóstico de fractura de húmero distal compleja tratados con reducción abierta y fijación interna entre 2015 y 2021. Se realizó un control radiográfico periódico y se evaluó el resultado funcional mediante escalas internacionales, como DASH y MEPS. Luego se procedió a extrapolar las variables obtenidas utilizando un programa estadístico. Resultados: Se logró la consolidación de todas las fracturas. Se empleó el abordaje de Alonso Llames en 7 pacientes (37%) y la osteotomía de olécranon en 12 casos (63%). El puntaje DASH promedio fue de 11,31, lo que determinó discapacidades leves. El puntaje MEPS obtenido fue excelente en un paciente (5,26%), bueno en 10 (52,6%), regular en 7 (36,84%) y pobre en 1 (5,26%). Conclusiones: La reducción abierta y la fijación interna son eficaces para tratar las fracturas complejas de húmero distal, permiten lograr buenos resultados posquirúrgicos. En esta serie, el 57% de los pacientes obtuvo resultados excelentes o buenos. No se halló una diferencia estadísticamente significativa con respecto a la elección de un abordaje u otro. Nivel de Evidencia: IV

Objective: To describe the results obtained in the treatment of distal humerus fractures by open reduction and internal fixation (ORIF) and to reflect whether the approach used had an impact on the functional outcome. Materials and methods: We carried out a retrospective case study of 19 patients with a diagnosis of complex distal humerus fracture who were treated with ORIF from 2015 to 2021. Periodic radiographic controls were performed and the functional outcome was evaluated using internationally known scales such as the DASH and Mayo Elbow performance Score (MEPS), then the variables obtained were extrapolated using statistical software. Results: A 100% consolidation rate was achieved; in 7 patients (37%), the Alonso Llames approach was used and in 12 cases (63%), we performed an olecranon osteotomy. The average DASH was 11.31, which determined mild disabilities. The MEPS obtained was excellent in 1 patient (5.26%), good in 10 (52,6%), fair in 7 (36.84%), and poor in 1(5.26%). When comparing the results obtained through the different approaches a P = 0.4197 was obtained in the ANOVA test and P =0.4723 in the Mann-Whitney/Wilcoxon Two sample Test. Conclusions: We conclude that ORIF is effective in the treatment of complex fractures of the distal humerus, allowing the surgeon to obtain good post-surgical results. In this series, the average DASH was 11.31, with excellent and good results in 57% of the patients. We found no statistically significant difference regarding the choice of one approach or the other. Level of Evidence: IV

Epidemiological study of prevalent pathogens in the Northwest region of Argentina (NWA).

Northwest Argentina (NWA) is a poor economic-geographical region, with the highest rate of diarrhea diseases. At the moment, there are no reports showing the epidemiological status of this region that would allow to establish methods for prevention and control of these infections and to indicate of the prevalent pathogen that produces them. Therefore we carried out an epidemiological study of the gastroenteritis etiological agents and their incidence in the pediatric population. A total of 17 823 fecal samples were collected, 14 242 from HNJ-Tuc, 2,257 from CePSI-Stgo and 1,324 from HINEP-Cat. In 2,595 samples a bacterial agent was identified, the 93.64% corresponded to Shigella/Salmonella clinical isolates. Shigella genus was the prevalent pathogen, being Shigella flexneri 2 the most frequent serotype. Most of the Shigella clinical isolates presented themselves as multidrug-resistant (MDR), harboring 2 to 3 genetic resistance determinants. 50% of the affected patients were children under 4 years old. Here, we demonstrate that bacterial gastrointestinal diseases strongly affect the health of NWA population. The appearance of epidemic outbreaks, as happened during 2014, suggest that they may be related to the socio-economic poverty of NWA. Recently, Shigella flexneri 2 has become the highest NWA´s incidence infectious agent. The acquisition of new antibiotic resistance determinants may play an important role in their adaptation and persistence.

Gross anatomy of the shoulder and arm intrinsic muscles in the white-footed tamarin (Saguinus leucopus - Günther, 1876): Inter- and intraspecific anatomical variations.

BACKGROUND: Saguinus leucopus is a Neotropical primate with an arboreal quadrupedal locomotion pattern, which requires wide movements of the shoulder and arm. This investigation studies the muscles of these regions in order to serve as a basis for clinical and surgical procedures and to compare with other primates. METHODS: Gross dissections of twenty thoracic limbs were performed. RESULTS: The muscles examined were the deltoid, supraspinatus, infraspinatus, subscapularis, teres major, teres minor, coracobrachialis longus, coracobrachialis brevis, biceps brachii, brachialis, triceps brachii, tensor fasciae antebrachii, and anconeus epitrochlearis. The anconeus was absent. The following variants were found: an accessory head of the biceps brachii, the unilateral absence of the short head of the biceps brachii, an accessory head of the coracobrachialis longus, and one infraspinatus muscle innervated by the axillary nerve. CONCLUSIONS: These muscles are adapted to quadrupedal locomotion and can have inter- and intraspecific variations in their attachments and innervation.

Terapia endovascular múltiple para el manejo del vasoespasmo cerebral refractario / Repeated endovascular therapy for refractory cerebral vasospasm

Resumen El vasoespasmo cerebral es una complicación severa de la hemorragia subaracnoidea. La monitorización y la detección del vasoespasmo por mé- todos no invasivos, así como la terapia endovascular, han revolucionado la atención médica tradicional. Se presenta el caso de un paciente masculino de 45 años con aneurisma roto de la arteria comunicante anterior, quien desarrolló vasoespasmo severo refractario desde el octavo día de hemorragia subaracnoidea. El vasoespasmo fue detectado oportunamente con técnicas no invasivas y tratado en cinco ocasiones mediante terapia endovascular, logrando mejoría inmediata de los síntomas y sin secuelas neurológicas. Este reporte contribuye a demostrar el beneficio de la terapia endovascular múltiple para el manejo del vasoespasmo cerebral refractario, en combinación con la utilización de técnicas no invasivas para la monitorización y detección oportuna del vasoespasmo. Adicionalmente, se revisan las recomendaciones actuales de medicina basada en la evidencia sobre el uso del Doppler transcraneal para la detección del vasoespasmo cerebral.

Abstract Cerebral vasospasm is a severe complication of subarachnoid hemorrhage. Monitoring and detection of vasospasm by non-invasive methods as well as the endovascular therapy have revolutionized healthcare. A 45-years-old male patient presented with a ruptured aneurysm in the anterior communicating artery and developed severe refractory vasospasm since the eighth day of aneurysm rupture. Vasospasm was timely detected with non-invasive techniques and successfully endovascular therapy was provided five times with neurological and radiological recovery each time and no neurological sequelae. This report contributes to current practice as it demonstrates the benefit of repeated endovascular therapy for refractory cerebral vasospasm, especially when clinical and non-invasive monitoring shows persistence of this complication. Furthermore, we review the current evidence-based medicine recommendations about Transcranial Doppler Ultrasonography that support the monitoring and detection of cerebral vasospasm.

Morphometric, anatomic and radiographic study of the scapula in the white-footed tamarin (Saguinus leucopus): report of scapular cartilage and one variation in cranial (superior) transverse scapular ligament.

The white-footed tamarin (Saguinus leucopus) is an endangered endemic primate of Colombia, mainly due to the deforestation of its habitat and illegal trade, which generates a high incidence of these animals in wildlife care centres. Musculoskeletal system disorders in S. leucopus are one of the most common diseases and therefore the aim of this study was to contribute to the morphologic studies with a morphometric, anatomic and radiographic description of the scapula in this species to provide a basis for medical interventions, surgical approaches, radiologic diagnoses and comparative functions of this bone. Gross dissections of each scapular region were made in eight specimens without a diagnosis of osteomuscular disease. These specimens died from natural cases in the wildlife care centres of the Corporación Autónoma Regional de Caldas (CORPORCALDAS); after necropsy their carcasses were fixed with 10% formaldehyde, 5% mineral oil and 1% phenic acid in these centres over the course of at least 1 week. X-rays of the scapula were taken in the small animal clinic of the Universidad del Tolima, and morphometric data of the scapulae were obtained with a digital calliper. The scapula of the white-footed tamarin was a flat triangular bone with a deep scapular notch in its cranial margin, where there was a cranial transverse scapular ligament that was absent in two specimens. The coracoid process was highly developed, medially covering the humeral joint. The dorsal margin was covered by the scapular cartilage, which was highly developed in the caudal angle. In the dorsal fourth of the caudal margin, there was a surface from which the m. teres major originated. The lateral surface had a scapular spine with a long hamatus process of the acromion until the lateral part of the humeral joint. The infraspinatus fossa was wider than the supraspinous fossa. On the costal surface, the subscapular fossa was formed by three subscapular lines and one subscapular ridge, the latter helping to form the surface for the m. teres major. In the two radiographic views, caudocranial to the scapula and dorsoventral to the thorax, the scapular spine, acromion, coracoid process, scapular incisura, supraglenoid tubercle, caudal margin, subscapular ridge, and the joints with the clavicle and the humerus could be observed. The scapula of the white-footed tamarin presented bony reliefs that share characteristics with other primates but also with domestic mammals due to its quadrupedal locomotion, which allowed us to correlate its morphologic adaptation with its quadrupedal arboreal displacement.

Síndrome de Budd-Chiari agudo secundario a cirrosis alcohólica. Manejo intervencionista y descripción de una complicación / Acute Budd-Chiari Syndrome Secondary to Alcoholic Cirrhosis. Interventional Management and Description of a Complication

El síndrome de Budd-Chiari (SBC) es una patología poco frecuente y potencialmente fatal si no se diagnostica y se trata a tiempo. Se describe un caso de SBC secundario a obstrucción de la vena cava inferior intrahepática y venas suprahepáticas izquierda y media, con manejo intervencionista (colocación de endoprótesis en la vena cava) y posterior complicación con migración de la endoprótesis a la arteria pulmonar

Budd-Chiari syndrome (BCS) is an infrequent and potentially fatal disease if not diagnosed and treated early. We describe a case of BCS secondary to obstruction of intrahepatic inferior cava vein and left and middle suprahepatic veins, with interventional management (stent placement in the cava vein) and subsequent complication with stent migration to the pulmonary artery.

Paraoxonase-1 is only present in traceable amounts in seminal fluid and does not show any relationship with male subfertility.

UNLABELLED: Study Type - Aetiology (case series). LEVEL OF EVIDENCE: 4. What's known on the subject? and What does the study add? Oxidative stress seems to be one of the biochemical causes of defective sperm function. Paraoxonases are antioxidant enzymes that degrade lipid peroxides. There is a paucity of data on the possible role played by these enzymes in the pathophysiology of male sub-fertility. The present study shows that testicular tissue of sub-fertile patients clearly expresses paraoxonases-1, 2, and 3. These findings suggest a role for these enzymes in the protection against lipid peroxidation inside the cell. However, the concentration and activity of paraoxonase-1 in semen are negligible and are probably the result of cellular catabolism, with no significant biological function. OBJECTIVE: To characterise the immunohistochemical sites of paraoxonase (PON) 1, PON2 and PON3 in human testicular tissue, and to analyse PON1 levels in semen, aiming to investigate the role played by these enzymes in the pathophysiology of male subfertility. PATIENTS AND METHODS: The present study was performed in 41 semen samples from normal donors and in 52 semen samples and ten testicle biopsies from patients who were being evaluated for causes of subfertility. RESULTS: Immunohistochemical analyses showed high levels of PON1 and PON3 expression in testicular tissue. PON2 expression was also detected, albeit at weaker levels. Oxidative stress indicators in biopsies were low and localized in some specific areas of the seminiferous tubules. PON1 was detected in seminal fluid at very low levels but with no significant differences between patients and controls. Receiver-operating characteristic analysis showed a low diagnostic power of semen PON1 levels. CONCLUSIONS: The present study shows high protein expression levels of PON1, PON2 and PON3 in testicular cells. The concentrations and activities of PON1 in semen are negligible and are probably the result of cellular catabolism, with no significant biological function in the testes.

Early age renal synovial sarcoma.

OBJECTIVE: We report a primary renal Synovial Sarcoma (SS) case and analyze its features. METHOD: A 15 year old male presented with left abdominal mass and weight loss. CT scan images showed a 13 cm mass located in the lower pole of the left kidney. Renal biopsy recognized an undifferentiated neoplasm, the immunohistochemistry suggesting the probability of neuroectodermic primitive tumor versus SS. Chemotherapy and radical nephrectomy were carried out. Pathological study showed a big multilobulated necrotic tumor 22 x 13 x 12.5 cm. Histopathological study demonstrated a neoplasm composed by immature cells. Currently, patient has survived 1,8 years. A structured bibliographical search was performed in the Medline, Imbiomed and Scielo databases. RESULTS: The final immunohistochemistry studies gave the diagnosis of poorly differentiated renal SS small cell variety. CONCLUSION: The renal SS is extremely infrequent, with less than 40 cases reported, of which this case reports the earlier age. These tumors, when located in the kidney, represent a great diagnostic challenge that requires adequate clinical, radiological, surgical, and pathological correlation for appropriate diagnosis and treatment.

Sarcoma sinovial renal en edad temprana / Early age renal synovial sarcoma

OBJECTIVE: We report a primary renal Synovial Sarcoma (SS) case and analyze its features.METHOD: A 15 year old male presented with left abdominal mass and weight loss. CT scan images showed a 13 cm mass located in the lower pole of the left kidney. Renal biopsy recognized an undifferentiated neoplasm, the immunohistochemistry suggesting the probability of neuroectodermic primitive tumor versus SS. Chemotherapy and radical nephrectomy were carried out. Pathological study showed a big multilobulated necrotic tumor 22x13x12.5 cm. Histopathological study demonstrated a neoplasm composed by immature cells. Currently, patient has survived 1,8 years.A structured bibliographical search was performed in the Medline, Imbiomed and Scielo databases.RESULTS: The final immunohistochemistry studies gave the diagnosis of poorly differentiated renal SS small cell variety.CONCLUSION: The renal SS is extremely infrequent, with less than 40 cases reported, of which this case reports the earlier age. These tumors, when located in the kidney, represent a great diagnostic challenge that requires adequate clinical, radiological, surgical, and pathological correlation for appropriate diagnosis and treatment (AU)

OBJETIVO: Describir un caso de Sarcoma Sinovial (SS) renal primario y realizar una revisión sobre este tema.MÉTODO: Paciente masculino de 15 años de edad, con masa abdominal izquierda y pérdida de peso. A quien se documentaron por imágenes una lesión de 13 cm de diámetro, localizada en el polo inferior del riñón izquierdo, por lo cual, se realizó una biopsia renal, en la que se evidenció un tumor maligno indiferenciado, cuyos estudios de inmunohistoquimica sugerían los diagnósticos de tumor neuroectodermico primitivo Vs SS. Con lo anterior, iniciaron quimioterapia y realizaron nefrectomía radical. Actualmente el paciente presenta una sobrevida de 1.8 años.RESULTADO: Se reconoció gran tumor renal izquierdo, de 22x13x12.5cm, multilobulado, con áreas de necrosis. Cuyo estudio histopatológico mostro una neoplasia maligna indiferenciada, compuesta por sabanas de células inmaduras. Los estudios de inmunohistoquimica permitieron concluir el diagnóstico de sarcoma sinovial renal pobremente diferenciado de variedad de células pequeñas. Estrategia de búsqueda de la literatura. Se realizó una búsqueda estructurada de la literatura, en las bases de datos Medline, Imbiomed y Scielo.CONCLUSIÓN: Los SS de localización renal son extremadamente infrecuentes, con menos de 40 casos reportados, del cual se presenta el caso informado a edad más temprana. Estos tumores cuando se localizan en el riñón, representan un gran reto diagnóstico que requiere de la adecuada correlación clínico, imagenologica, quirúrgica, y patológica para su adecuado diagnóstico y manejo (AU)