Protocol for percutaneous tracheostomy and prevention of COVID-19 transmission.

INTRODUCTION: Currently we are faced with countless patients with prolonged invasive mechanical ventilation as a result of the COVID-19 pandemic, with the consequent increase in the need for tracheostomies and the risks that this includes for both patients and staff. OBJECTIVE: It is necessary to establish a safety protocol for the performance of percutaneous tracheostomies in order to reduce the associated infections. MATERIAL AND METHODS: 77 patients underwent tracheostomies between March 2020 and March 2021, evaluating the safety of the protocol and the rate of contagion among the staff. RESULTS: Percutaneous tracheostomy was performed according to the protocol in 72 patients, 5 were excluded due to unfavorable anatomy or other reasons. There were no cases of SARS COVID-19 contagion among health personnel attributable to the procedure during the three-week follow-up period. There were no surgical complications in this series. CONCLUSION: The authors recommend implementing security protocols such as the one discussed in this work, given its low contagion rate and ease of implementation.

Unassisted percutaneous tracheostomy: A new flow chart decision making based on simple physical conditions.

INTRODUCTION: Percutaneous dilatation tracheostomy (PDT) has several advantages over traditional surgical tracheostomy. However, it is still performed using bronchoscopy guidance. OBJECTIVE: To suggest the safety of unassisted PDT, without bronchoscopy guidance, based on bed-side screening flow chart evaluation. MATERIAL AND METHODS: 180 consecutive UCI patients referred to tracheostomy were submitted to Avalo's Screening Chart (ASC), in order to decide surgical technique. RESULTS: 161 patients were referred to unassisted PDT (un PDT) and 19 to surgical tracheostomy (ST) due to nonfulfillment of ASC steps. 10 patients submitted to unassisted PDT presented early complications, 8 presented mild bleeding and 2 false tracts. None of 6 months follow up patients presented long term complications. CONCLUSION: The authors suggest unPDT is a safety surgical method in UCI patients who were submitted and approved to an easy anatomical and clinical screening chart (ASC).

Head and neck cancer in young people: a series of 52 SCCs of the oral tongue in patients aged 35 years or less.

CONCLUSION: Prognosis was very poor as soon as a local failure developed. Up-front treatment should be optimized to control this rare disease. We propose producing and reporting recommendations via a concerted oncologic physician referral network. OBJECTIVES: Squamous cell carcinoma (SCC) in young people is rare and the literature is confusing. This study was carried out to assess the demographics, clinical features, and treatment outcome in a cohort of patients aged 35 years or less with SCC of the oral tongue (SCCOT). PATIENTS AND METHODS: This was a multicenter retrospective study. Fifty-two patients treated between 1990 and 2000 were identified. Descriptive statistics were analyzed to assess demographic and tumor variables. RESULTS: The WHO performance status was excellent for all patients. Thirty-seven were classified as T1-T2 and 38 were N0. All of them except one were treated with curative intent. Treatment failures were observed in 25 patients (48%). Four patients could be successfully salvaged after SCCOT recurrence or progression. The disease-free survival (DFS) was 52% at 5 years. The 5-year overall survival (OS) rate was 64%. Factors that affected the OS were invasion of the floor (p=0.009), cross over of the midline (p=0.02), positive lymph nodes (p=0.02), and the lack of disease control (p=0.0001).

Medición de presión intrabdominal por método intravesical: validación de la técnica en humanos / Intra-abdominal pressure measurement using intravesical method: validation of the technique in humans

Currently the compartmental abdominal syndrome is recognized as a relevant clinical picture in the context of the critical surgical patient. For an adequate diagnosis and handling of the picture, measurement of the pressure in the mentioned compartment, the abdomen is fundamental. Several methods have been applied with this objetive, where the most utilized is that of intra-vesical measurement. The objetive of our study is the validation of the technique of intra-vesical measure of pressure in humans. Patients that are to undergo laparoscopic surgery were included. Intra-abdominal pressure was measured via intra-peritoneal de Veres needle technique associated to a CO2 insufflator performing increasing pressure curve up to tha safe limit of (18 mmHg. Parallely the intra-vesical pressure was measured with a three-way N°18 Foley probe (latex, Kendall), adjusting the secondary way to a pressure transducer. 20 patients were evaluated, with a total of 220 measurements. Through linear regression method a strong positive correlation was observed between de Veres needle and Foley probe with r = 0.713, P=0,00001. The method seems valid with a projected line of y = 4.77 + 0.69x, for a 95 per cent confidence interval. There were two cases where, clearly for the observer, there was no correlation, in one of them due to multiple previous surgeries (it was even necessary to change to open surgery) and in another case it was an obese patient (IMC 29.56). We come to the conclusion that measurement of intravesical pressure as a method for evaluating the intra-abdominal pressure is adequate on humans, considering a lower sensitivity to the changes in abdominal pressure, therefore the clinical conduct in the particular case must be taken with several measurements and associated to the relevant symptomatology described for the abdominal compartmental syndrome. We also recommend precaution on obese patients and those with multiple previous surgeries.

Microcirugía vascular cuando no hay vasos venosos utilizables en el cuello / Vascular microsurgery when there aren't usable venous vessels in the neck

La reconstrucción microquirúrgica de los grandes defectos posteriores a terapia resectiva en cáncer de cabeza y cuello ha sido un gran aporte que ha permitido mejorar resultados funcionales, estéticos y quirúrgicos de estos pacientes. Presentamos un caso clínico de reconstrucción microquirúrgica cervical en el cual no habían vasos receptores en el cuello, mostrando la solución mediante la utilización de un vaso recipiente que se encontraba fuera del territorio cervical: la vena cefálica

Renal effects of experimental obstructive jaundice: morphological and functional assessment

Background. The pathophysiology of renal impairments occurring in obstructive jaundice has been extensively studied, but underlying mechanism of these derangements remains unclear. The aim of the present study was to investigate the time-related morphological and functional changes occurring in the kidneys of rats undergoing obstructive jaundice. Methods. Histological examination, renal function assessment and determination of (Na + K)-ATPase activity were performed in the kidneys of rats 7, 14, and 21 days following bile duct ligation (BDL) or sham operation (sham). Results. Glomerular filtration rate was unaffected by BDL throughout the period of the study. Tubular effects occurred at days 7 ant 14, being more marked at day 7, and consisted of an increase of about twice in the fractional excretion of sodium and chloride, paralleled by a decreased proximal and distal tubular reabsorption of sodium of about 50 and 40 percent, respectively. Natriuresis was consistent with augmentation of osmolar clearance but it was not associated with changes in the acivity of renal (Na+ + K+)-ATPase. The ability to dilute urine was imparied at days 14 and 21 after BDL. Additionally, these effects were accompanied by decreased tubulointerstitial fibrosis and vasodilation of inner medullary capillaries. At day 21, the parameters of tubular function in BDL and sham groups were not significantly different. Conclusions. These data support the view that rasied natriuresis taking place in the initial 2 weeks following BDL is due mainly to tubular effects. The contribution of hemodynamic, paracrine and humoral mediators is discussed