Primary hepatic gastrinoma, extremely rare case presentation and its surgical resolution, in a third level hospital in Mexico.

The gastrinomas are rare functional neuroendocrine neoplasms, most are localized to the duodenum (70-90%) or the pancreas (2-30%), but less common ectopic sites have been reported. The primary hepatic gastrinoma is extremely rare, with less tan 40 cases reported in the medical literature. Its low incidence and its non specific clinical presentation make it a difficult disease to diagnose. Providing a timely diagnosis the patient can be treated by surgical resection with high chances of success. The objective of this paper is to describe a case of primary hepatic gastrinoma in Mexico, successfully treated by right liver segmentectomy.

Los gastrinomas son neoplasias neuroendocrinas funcionales raras, y la mayoría se localizan en el duodeno (70-90%) o en el páncreas (2-30%), pero también existen otras localizaciones ectópicas poco comunes. El gastrinoma hepático primario es extremadamente raro, con menos de 40 casos reportados en la literatura médica. Su baja incidencia y su presentación clínica inespecífica lo convierten en una enfermedad difícil de diagnosticar. Al realizar un diagnóstico oportuno puede ser tratado mediante resección quirúrgica con altas posibilidades de éxito. El objetivo de este trabajo es presentar un caso clínico de gastrinoma hepático primario en México, tratado de manera exitosa mediante segmentectomía hepática derecha.

Assesing Intraoperative Virtual Navigation on My Craniofacial Surgery Fellowship for Orbital Fractures Repair: Is it Useful?

ABSTRACT: Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory restoration of normal orbital volume and globe projection following traumatic injury, due to the inability of the surgeon to gain adequate visibility and to verify proper implant position and placement during the operation. Surgical navigation is a very helpful tool when dealing with the reconstruction of such orbital fractures. During the training of the craniofacial fellowship learning to recognize the orbital floor boundaries is essential for the correct implant placement for reconstruction, their identification is a critical step, which may be assisted by intraoperative virtual navigation. Six patients were surgically treated for orbital floor fracture with intraoperative virtual navigation. The clinical evaluation showed no complications such as enophtalmos, exophtalmos or dystopia in all the patients 2 months post operatively and a correct implant/graft position.During surgery, navigation provides exact determination of transverse, cranio-caudal and postero-anterior dimensions within the orbit and precise control of the position of implants/bone grafts.This tool aids consistently on the craniofacial surgery fellow's formation, as it facilitates the identification of the bony floor boundaries and verifies the correct placement of the implants/bone grafts. It is routinely use could help to avoid implants/bone grafts misplacement not only for craniofacial surgeon's fellow, but for all the orbital surgeons.

Adyuvancia en tratamiento quirúrgico de fibroma osificante. A propósito de un caso / Adjuvance in surgical treatment of ossifying fibroma. Case report

El fibroma osificante es una neoplasia osteogénica benigna que representa el 3.1% de los tumores orales y el 9.6% de las lesiones gingivales. Su tratamiento de elección es la enucleación por curetaje completado hasta márgenes de hueso sano, con una recurrencia de aproximadamente el 7-20% probablemente por remoción incompleta, irritación continua o daño repetido. Presentamos un caso clínico en el que complementamos el tratamiento quirúrgico con métodos adyuvantes para disminuir la recurrencia y acelerar la regeneración ósea mediante uso de nitrógeno líquido y hueso liofilizado cadavérico combinados con plasma rico en plaquetas. En el control postoperatorio a los 6 meses no evidenciamos recurrencia clínica o radiológica y comprobamos regeneración ósea acelerada. Sugerimos el uso en este tipo de lesiones de nitrógeno líquido como adyuvante para la prevención de recurrencia, hueso liofilizado para favorecer la regeneración ósea guiada y plasma rico en plaquetas para acelerar el proceso de curación ósea

Ossifying fibroma is a benign osteogenic neoplasm, representing 3.1% of oral tumors and 9.6% of gingival lesions. Enucleation by curettage is the treatment of choice, completed to healthy bone margins, with a recurrence of approximately 7-20%, probably due to incomplete removal, continued irritation or repeated damage. We describe a clinical case ttreated in combination with adjuvant methods to decrease recurrence and accelerate bone regeneration, with the placement of liquid nitrogen and cadaveric lyophilized bone, combined with platelet-rich plasma. Post-operative control at 6 months showed no clinical or radiological evidence of recurrence and the presence of accelerated bone regeneration. We suggest liquid nitrogen as an adjuvant for the prevention of recurrence and bone regeneration guided with lyophilized bone in conjunction with platelet-rich plasma as a feasible option to accelerate the bone healing process

The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia.

The purpose of orthognathic surgery procedures is to manipulate the elements of the facial skeleton to reestablish normal anatomy and function. These elements could be repositioned with the technique known as Le Fort I osteotomy. This technique can be modified to be adapted on each patient, depending on the anomaly presented and the planned objective. The versatility, offered by the modifications of the Le Fort I osteotomy, has taken us to design one that allows the capability to correct the malar region hypoplasia in the same surgical procedure. A total of 9 patients were included with malocclusion as indication for orthognathic surgery who also presented with malar hypoplasia diagnosed clinically and cephalometrically. A modified technique, the "U"-shaped maxillary osteotomy, was performed with excellent functional and aesthetics results, and none of the patients presented complications associated directly to the maxillary osteotomy. Some patients with maxillary zygomatic deficiency combined with malocclusion continue to present a special challenge to clinicians treating these deformities. This technique is useful in improving zygomatic projection in bloc with the Le Fort I advancement without the need to place a bone graft and the advantage of rigid fixation along with the one used in the Le Fort I osteotomy. The U-shaped maxillary osteotomy is a safe, trustworthy, and reproducible technique that allows the resolution of the maxillomalar hypoplasia in a single surgical time, providing satisfactory aesthetic results. Any surgeon with adequate training in orthognathic or craniofacial surgery could perform it and incorporate it to his technical armamentarium.

Le Fort II Osteotomy and Modified Technique Presentation.

INTRODUCTION: The LeFort II osteotomy has a specific number of indications, thus this is true, there is less experience with the technique. The authors present a modification to the technique and extensive step-by-step procedure explanation in order to share their experience for making a safe surgery. MATERIAL AND METHODS: A clinical report is presented of a nonsyndromatic patient with nasomaxillary hypoplasia, in which the authors make an LeFort II osteotomy with circumvestibular, transcaruncular, and "W"-shaped approaches, with minimal scar showing, in order to offer better aesthetic outcomes as well as functional and skeletal. RESULTS: Patient presenting with an optimal postoperative clinical and skeletal results. Cephalometic measurments in normal ranges. Obtaining during the process of the surgery, description the surgery, and potential complications. CONCLUSION: Using the Le Fort II osteotomy in nonsyndromic nasomaxillary hypoplasia is a helpful and left away technique, because of its complexity. The authors give a step-by-step detailed description of the surgical technique with perioperative management. In summary, the steps provided give unique information about this reproducible and aesthetic technique.

Protocolo fast track ("rápida implementación") disminuye el tiempo de estadía hospitalaria, y el tiempo de inicio de la alimentación por vía bucal, en el paciente sometido a cirugía colorectal electiva / Fast track decreases the hospital stay, the time of begining of oral feeding in the patient undergoing, elective colorectal surgery

Introducción: el protocolo "fast track" (rápida implementación) ha revolucionado a la cirugía colorectal. Algunos cirujanos aún efectúan la preparación preoperatoria para los pacientes que serán sometidos a cirugía colorectal. El propósito de este escrito es el de comparar los resultados entre el protocolo "fast track "y la cirugía convencional en la preparación de los pacientes sometidos a cirugía colorectal por afecciones benignas. Métodos: desde enero 2012 hasta agosto 2015, los pacientes operados por cirugía colorectal debido a afecciones benignas se incluyeron en el estudio. El grupo de comparación consistió en pacientes con cirugía colónica mayor con cuidado convencional y el "fast track". Resultados: hubo 86 pacientes en total, 43 para cada grupo. Ambos grupos eran similares. Los pacientes con cuidado convencional tuvieron una estadía hospitalaria mayor y de inicio de la alimentación por boca comparada con los pacientes del protocolo "fast track", p = 0.000 para ambas diferencias. Las complicaciones postoperatorias y las reoperaciones fueron similares en ambos grupos, sin ninguna diferencia significativa, p>0.05. No hubo fallecimientos en los dos grupos. Conclusión: el protocolo "fast track" es efectivo en la cirugía colorectal electiva porque disminuye el tiempo del comienzo de la alimentación por boca y el de la estadía hospitalaria en los pacientes, sin comprometer la seguridad.

Introduction: The Fast-track protocol has revolutionized colorectal surgery. Some surgeons still perform preoperative preparation for patients undergoing colorectal surgery. The aim of this paper is to compare the results between the Fast-track protocol and conventional surgery in preparing patients undergoing colorectal surgery for benign disease. Methods: From January 2012 to August 2015, the patients operated for colorectal surgery for benign diseases were included. The comparison group consisted of patients with major colon surgery with conventional care and Fast-track. Results: There were 86 patients in total, 43 in each group. Both groups were similar. Patients with conventional care had higher hospital stay and start of oral feeding compared to patients in Fasttrack protocol,p = 0.000 for both differences. Postoperative complications and reoperations were similar in both groups, with no significant difference, p> 0.05. There were no deaths in both groups. Conclusion: Fast-track protocol is effective in elective colorectal surgery because it decreases the start time of the oral feeding and the hospital stay of patients without compromising safety.

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma.

OBJECTIVES: Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. MATERIALS AND METHODS: This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients. RESULTS: The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction. CONCLUSION: Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

Distribución de morfina y opioides / CURRENT STATUS AND DISTRIBUTION OF MORPHINE AND OPIOIDS

La liberación del uso terapéutico de los opioides se ha hecho cada vez mas frecuente como una propuesta para mejorar la distribución de éstos en las instituciones de salud pública y privadas con el fin de garantizar su alcance a población que cursa con dolor. A pesar de esto, aún no se logra una distribución homogénea de estos recursos en la población requirente. El objetivo de este trabajo es dar a conocer el panorama actual de los opioides en México y algunos países sudamericanos.

The release of therapeutic opioid use is mentioned with increasing frequency as a proposal to improve their tion in Public and Private Health Care Institutions, in order to scope opioids to population who needs them. Although this, homogeneous distribution of opioids is not achieved. The aim of this paper is to present the current panorama of opioids in Mexico and Latin American countries

Costes directos de atención médica del pie diabético en el segundo nivel de atención médica / Direct costs in the management of diabetic foot

Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes.

Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.

[Chronic appendicitis due to multiple fecaliths. A case report]. / Apendicitis crónica ocasionada por fecalitos múltiples. Reporte de un caso.

BACKGROUND: The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported. CLINICAL CASE: Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis. CONCLUSIONS: The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found.

[Acute urinary retention secondary to giant prolapsed ureterocele in a young adult woman. Case report]. / Retención aguda de orina secundaria a prolapso de ureterocele gigante en una mujer adulta joven. Informe de un caso.

BACKGROUND: Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. CLINICAL CASE: Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. DISCUSSION: Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. CONCLUSION: The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient.

[Amyand's hernia and complicated appendicitis; case presentation and surgical treatment choice]. / Hernia de Amyand y apendicitis complicada; presentación de un caso y elección de tratamiento quirúrgico.

BACKGROUND: A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08-0.13%. CLINICAL CASE: Male of 43 years old, began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. DISCUSSION: Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. CONCLUSION: An extremely rare condition is presented, with a surgical choice that led to a favourable outcome.

[Surgical treatment for liver haematoma following endoscopic retrograde cholangiopancreatography; An unusual case]. / Tratamiento quirúrgico para hematoma subcapsular hepático posterior a colangiografía retrógrada endoscópica; caso inusual.

BACKGROUND: Even in expert hands, there can be serious complications when performing an endoscopic retrograde cholangiopancreatography. The most frequent complications are pancreatitis, cholangitis, bleeding, perforation, and acute cholecystitis. The hepatic subcapsular haematoma is a rare complication, with few cases described worldwide. OBJECTIVE: A case is presented of an extremely rare complication of endoscopic retrograde cholangiopancreatography, which required surgical treatment for its resolution without success. This is second case of mortality reported in the literature. CLINICAL CASE: Female patient of 30 years old, with indication for endoscopic retrograde cholangiopancreatography due to benign strictures. A hydro-pneumatic dilation and stent placement of 2 gauge 10 fr was performed. She presented abdominal pain after the procedure and significant decline in haemoglobin with no evidence of haemodynamic instability so an abdominal tomography scan was performed, showing no evidence of liver injury. The patient was haemodynamic unstable within 72 h. A laparotomy was required for damage control, with fatal outcome in the intensive care unit due to multiple organ failure. CONCLUSION: Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography is a rare complication, with few cases reported in the literature. Treatment described in the literature is conservative, resulting in a satisfactory resolution.

[Experience in nephron-sparing surgery in patients with small renal tumors]. / Experiencia en cirugía preservadora de nefronas en pacientes con tumores renales pequeños.

BACKGROUND: Nephron -sparing surgery is currently the treatment of choice for surgical removal of solid renal tumours smaller than 7 cm, in the case of a solitary kidney, bilateral renal tumours or the presence of chronic renal failure. MATERIAL AND METHODS: An observational, descriptive, retrospective and cross-sectional study was conducted. The variables evaluated were: age at diagnosis, gender, intraoperative blood loss, operative time, preoperative tumour size, hospital stay, pathology report, pTNM classification, Fuhrman nuclear grade, pre- and post-operative creatinine, monitoring for cancer. All were analysed using SPSS v 22. RESULTS: The study included 28 patients, 14 male and 14 women, with a mean age 52.3 years. The approach was lumbotomy in all patients. The mean hospital stay was 4.1 days. Mean perioperative bleeding loss was 380.3 ml. The mean preoperative creatinine was 0.96 mg/dl, with a post-operative mean of 1.12 mg/dl. Histopathology reported, 23 clear cell tumours, 2 angiomyolipomas, 2 oncocytomas, and 1 haemorrhagic cyst. Tumour staging was performed on 14 patients, with 13 patients T1bN0M0, and 1 patient T2aN0M0. In clear cell tumours, Fuhrman nuclear grade 2 was present in 16 patients and 7 patients were Fuhrman grade 3. CONCLUSION: Nephron sparing surgery is the choice procedure of choice in patients with small renal tumours, with good functional results without significant alteration in renal function. Outcome is optimal, with a low incidence of complications.

Efficiency in bracket bonding with the use of pretreatment methods to tooth enamel before acid etching: sodium hypochlorite vs. hydrogen peroxide techniques.

Bond failures are produced by the existence of biofilm on the tooth surface. Because biofilm is impermeable, it prevents contact in many areas, reducing the etching effect which selectively dissolves calcified tissues but does not seem to eliminate biofilm from the tooth surface, and thus the bond between the tooth and the bracket is not strong enough. The aim of this study is to compare bracket bonding efficiency with two dental surface pretreatments: sodium hypochlorite vs. hydrogen peroxide techniques. This was a cross-sectional, comparative, in vitro study. Seventy-five premolars extracted for orthodontic purposes were evaluated. They were divided into three groups of 25 teeth and assigned randomly toone of the pretreatment techniques (5.25%sodium hypochlorite or 3.5% hydrogen peroxide) or to a control group. The most efficient pretreatment technique for bonding to brackets was sodium hypochlorite, with an average of 17.15 (kg/F). Significant differences were observed between groups (p=0.0001). The post hoc bond strength test showed statistically significant differences between the sodium hypochlorite technique and the control group (p=0.0001). The sodium hypochlorite technique improves bracket adhesion to tooth enamel.

[Emphysematous gastritis secondary to gastric mucormycosis]. / Gastritis enfisematosa secundaria a mucormicosis gástrica.

BACKGROUND: Mucormycosis is a rare fungal infection of the mucorales order, which affects mostly immunocompromised patients. The association with emphysematous gastritis is rare and often fatal produced by gas -forming bacteria. We report the case of a trauma patient with type 1 diabetes mellitus, and diabetic ketoacidosis complicated with gastric mucormycosis associated with emphysematous gastritis. CLINICAL CASE: A male aged 32 who is involved in a car accident, who suffered head trauma, is admitted to the Intensive Care Unit, presenting diabetic ketoacidosis and upper gastrointestinal bleeding. An endoscopy was performed and an erosive esophagitis Class C, ischemia and gastric necrosis was found. A computed tomography scan showed emphysematous gastritis and gastric necrosis. He underwent total gastrectomy with a histopathology report of gastric mucormycosis. After the surgical procedure the patient died because of sepsis secondary to pulmonary mucormycosis DISCUSSION: Mucormycosis is a rare fungical disease which infrequently affects the gastrointestinal tract, being the stomach the most affected site. The mortality is high if the diagnosis is not done promptly and appropriate treatment is given. CONCLUSION: Suspecting its existence is necessary in patients with immunocompromised status to diagnose and provide timely treatment to increase survival, because of its high mortality.

Efficiency in bracket bonding with the use of pretreatment methods to tooth enamel before acid etching: sodium hypochlorite vs. hydrogen peroxide techniques

Bond failures are produced by the existence of biofilm on the tooth surface. Because biofilm is impermeable, it prevents contact in many areas, reducing the etching effect which selectively dissolves calcified tissues but does not seem to eliminate biofilm from the tooth surface, and thus the bond between the tooth and the bracket is not strong enough. The aim of this study is to compare bracket bonding efficiency with two dental surface pretreatments: sodium hypochlorite vs. hydrogen peroxide techniques. This was a cross-sectional, comparative, in vitro study. Seventy-five premolars extracted for orthodontic purposes were evaluated. They were divided into three groups of 25 teeth and assigned randomly toone of the pretreatment techniques (5.25%sodium hypochlorite or 3.5% hydrogen peroxide) or to a control group. The most efficient pretreatment technique for bonding to brackets was sodium hypochlorite, with an average of 17.15 (kg/F). Significant differences were observed between groups (p=0.0001). The post hoc bond strength test showed statistically significant differences between the sodium hypochlorite technique and the control group (p=0.0001). The sodium hypochlorite technique improves bracket adhesion to tooth enamel.

Las fallas de adhesion se producen por la existencia de la biopelicula en la superficie del organo dental, ya que es impermeable y no permite el contacto en muchas areas, de manera que disminuye el efecto del grabado acido; el cual tiene la capacidad de disolver selectivamente los tejidos calcificados, pero no parece eliminar la biopelicula en la superficie dental, por lo tanto, no se lleva a cabo la suficiente fuerza de adhesion en la interfase diente-bracket. El objetivo es comparar la eficiencia en la adhesion de los brackets con el empleo de dos metodos de pre-tratamientos de la superficie del esmalte, el hipoclorito de sodio vs. peroxido de hidrogeno. Estudio comparativo, transversal, in vitro. Se evaluaron 75 premolares extraidos con fines ortodoncicos, tres grupos de 25 dientes, asignados aleatoriamente con alguna de las dos tecnicas de pre-tratamiento al esmalte, hipoclorito de sodio al 5.25%, peroxido de hidrogeno al 3.5% y un grupo control. La tecnica de pre-tratamiento al esmalte mas eficiente para la fuerza de adhesion a los brackets fue el hipoclorito de sodio, con una media de 17.15 (Kg/F), se observaron diferencias significativas inter-grupos (p= 0.001). Las pruebas post hoc para las fuerzas de adhesion mostraron diferencia estadistica - mente significativa para la tecnica de hipoclorito de sodio/ grupo control (p=.001). La utilizacion de hipoclorito de sodio ayuda a mejorar la adhesion de los brackets en la superficie del esmalte.

[Zenker's diverticulum: election of surgical treatment and outcome. Case presentation]. / Divertículo de Zenker, elección del tratamiento quirúrgico y resultado. Presentación de un caso.

BACKGROUND: Zenker's diverticulum is a protrusion of the pharyngeal mucosa through a weak area of the posterior wall. It is a rare disorder with an incidence in Mexico of ~0.04% of the population. Its pathophysiology is not yet completely understood. Treatment is surgical and is performed in case of complications. Clinic case: We present the case of a 67 year-old male patient without comorbidities. Symptoms appeared 15 months prior to admission with occasional dysphagia to solids and liquids, breathing difficulty at night, drooling, halitosis, 3 kg weight loss in 2 months, and adequate appetite. Diagnosis of Zenker's diverticulum was established by imaging method and endoscopy. A diverticulectomy with cricopharyngeal muscle myotomy was successfully performed. Liquid diet was started the third postoperative day and progressed without complications; the patient was discharged on the sixth postoperative day without complications. Follow-up at 1 year was successful without recurrence. CONCLUSION: Minimally invasive procedures are useful in patients with comorbidities and for the short anesthesia time and hospitalization. Referring to our field of work, the open treatment is best to relieve symptoms rather than endoscopic procedures because the training for advanced endoscopic procedures is a problem due to lack of infrastructure and specialized personnel.

Antecedentes: los divertículos de Zenker son protrusiones de la mucosa faríngea a través de una zona débil de su pared posterior. Es un padecimiento raro, con una incidencia en México de aproximadamente 0.04% de la población. El tratamiento indicado es quirúrgico. Caso clínico: paciente masculino de 67 años de edad, que 15 meses antes del diagnóstico experimentó síntomas de: disfagia a sólidos y ocasionalmente a líquidos, ahogo por las noches, sialorrea, halitosis, pérdida de 3 kg en dos meses y aumento del apetito. El diagnóstico se confirmó a través de métodos de imagen y endoscopia. Se realizó exitosamente una diverticulectomía con miotomía de músculo cricofaríngeo. Al tercer día de operado pudo ingerir líquidos sin complicaciones, y fue dado de alta al sexto día. Un año después no había mostrado recurrencias. Conclusión: los procedimientos de invasión mínima son útiles en pacientes con comorbilidades porque requieren corto tiempo de anestesia y de hospitalización. En este medio, el tratamiento abierto es la mejor técnica para su resolución, ya que la capacitación para efectuar procedimientos endoscópicos representa un problema por la falta de infraestructura y personal especializado.