Síndrome confusional agudo y confusional subsindromático en terapia intensiva: evolución intrahospitalaria y a los tres meses del alta / Delirium and subsyndromal delirium in the intensive care unit: In-hospital outcomes and prognosis at discharge

Antecedentes y objetivo Las características y la evolución de los pacientes con confusional subsindromático (CSS) en la internación aún continúa en discusión. El objetivo fue describir la incidencia de síndrome confusional agudo (SCA) y CSS en terapia intensiva (UTI), analizar su asociación con la presencia de factores de riesgo y explorar diferencias en la evolución hospitalaria y a los tres meses del alta. Pacientes y métodos Estudio prospectivo con seguimiento telefónico tres meses luego del alta. Se aplicó el CAM-ICU para definir tres grupos: sin delirio (de referencia), CSS y SCA. Resultados En 270 pacientes, el 22,96% presentaron SCA y el 17,03%, CSS. Factores relacionados con mayor riesgo de SCA: deterioro cognitivo (p=0,000), edad ≥75años (p=0,019), motivo de ingreso neurológico (p=0,003), shock (p=0,043), escaras (p=0,010), polifarmacia (0,017), ARM (p=0,001) y reposo digestivo (p=0,028); con mayor riesgo de CSS: baja escolaridad (p=0,014), Charlson >5 (p=0,028), AIVD <8 (p=0,001), alimentación enteral (p=0,000) y motivo de ingreso no cardiovascular (p=0,019). La mortalidad global fue del 6% en el grupo sin delirio, del 8% en CSS (p=0,516) y del 30% en SCA (p=0,000). La mediana de internación en UTI fue de 2días (rango 1-2) en el grupo sin delirio, 3 (2-4) días en CSS (p=0,0001) y 3 (2-7) días en SCA (p=0,0001). A los tres meses del alta, las AIVD estaban conservadas en el 50% del grupo sin delirio, en el 30% de CSS (p=0,026) y en el 26% de SCA (p=0,005). Conclusiones El CSS presentó un pronóstico intermedio entre el grupo sin delirio y el SCA. Se aconseja su diagnóstico para mejor clasificación de riesgo (AU)

Background and objective The characteristics and outcomes of patients with subsyndromal delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirium and SSD in the intensive care unit (ICU), to analyze the association with risk factors and to explore outcomes of delirium and SSD at hospitalization and three months after discharge. Patients and methods A prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU. Results 22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age ≥75years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (P=.017), ARM (P=.001) and fast (P=.028), and with the development of SSD were low schooling (P=.014), Charlson >5 (P=.028), AIVD <8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1-2) days in the group without delirium, 3 (IQR, 2-4) days in SSD (P=.0001), and 3 (IQR, 2-7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005). Conclusions The SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification (AU)

Delirium and subsyndromal delirium in the intensive care unit: In-hospital outcomes and prognosis at discharge. / Síndrome confusional agudo y confusional subsindromático en terapia intensiva: evolución intrahospitalaria y a los tres meses del alta.

BACKGROUND AND OBJECTIVE: The characteristics and outcomes of patients with subsyndromal delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirium and SSD in the intensive care unit (ICU), to analyze the association with risk factors and to explore outcomes of delirium and SSD at hospitalization and three months after discharge. PATIENTS AND METHODS: A prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU. RESULTS: 22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age ≥75years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (P=.017), ARM (P=.001) and fast (P=.028), and with the development of SSD were low schooling (P=.014), Charlson >5 (P=.028), AIVD <8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1-2) days in the group without delirium, 3 (IQR, 2-4) days in SSD (P=.0001), and 3 (IQR, 2-7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005). CONCLUSIONS: The SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification.

Diversity of Lacewings (Neuroptera) in an Altitudinal Gradient of the Tacaná Volcano, Southern Mexico.

Neuroptera is an order of insects with a moderate diversity of species numbers yet a high between-family morphological diversity, which has a significant ecological role as a predator. However, there are few studies focused on describing changes in species diversity along environmental gradients. We evaluated changes in the alpha and beta diversity of species and the higher taxa in Neuroptera communities in the Tacaná Volcano in southern Mexico. Five sites each at different altitudes were studied through systematic annual sampling. The taxonomic and phylogenetic alpha diversity were analyzed, as well as the beta diversity and its components, species turnover and nestedness. The alpha diversity had two trends: (1) decreased standardized richness and taxonomic distinctness with increasing altitude, and (2) increased estimated richness and species diversity at intermediate altitudes. The highest turnover values for species, as well as for supra-specific taxa, were recorded at sites with lower altitudes. The highest total beta diversity value was recorded at elevations above 3000 m, whereas the highest number of species and supra-specific taxa were observed at sites between 600 and 2000 m, with an evident decrease above 3000 m. The type of vegetation and environmental conditions may be influencing the decrease in diversity toward higher elevations, which could explain the niche specialization of Neuroptera species to particular sites within the gradient. These results highlight the need to study the environmental factors and their effects on species composition along an elevation gradient.

First record of the genus Lainius Navás, 1913 (Neuroptera: Chrysopidae) in Mexico, with notes on the distribution of Apochrysinae

ABSTRACT The species Lainius constellatus Navás is recorded for the first time from Mexico; thus this report represents the northernmost record of the genus and species for the Americas. In addition, it provides data on the variation in color marks and a description of the hypandrium internum. A brief summary of the distribution of the species belonging to the subfamily Apochrysinae is provided, with emphasis on the three American genera, which share distribution mostly in the Pacific domain of the Brazilian subregion, ranging from the Mexican transition zone to possibly the Chacoan subregion.

Análisis clínico-tomográfico en obstrucción de intestino delgado por adherencias según el sitio de obstrucción en la tomografía / Clinical-tomographic analysis in adhesive small bowel obstruction according to obstruction site in the tomography

Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias. Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel. Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal. Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.

Introduction. Postoperative adhesions are the most common cause of small bowel obstruction. The clinical presentation suggests the diagnosis, but imprecisely the cause and the site of the obstruction. Contrast computed tomography is the optimal study and allows the timely identification of patients requiring surgical intervention. The objective of this study was to analyze the correlation between the symptoms and the obstruction site detected in the abdominal contrasted computed tomography in patients with suspected diagnosis of small bowel obstruction due to adhesions. Methods. Prospective, cross-sectional and analytical study of patients with clinical suspicion of small bowel obstruction due to adhesions and surgical history, and its correlation with the obstruction site detected in the abdominal contrasted computed tomography, during March 2016 to February 2019 in a secondary level hospital. Results. Forty-one patients were included, the mean age was 59 years and the male gender was the most frequent (68.3%, n=28); the absence of evacuations was present in 97.5% (p=0.026). Contrast computed tomography showed the obstruction site in 73% of the patients. The most prevalent location of the obstruction was in the distal ileum (31.7%, n=13). It was associated with leukocytosis (p=0.041) and more intense pain (p=0.049), without presenting peritoneal irritation. Conclusion. The obstruction located in the distal ileum was characterized by more pain and a higher white blood cell count, without correlation as a risk factor for requiring surgical treatment

[Toxic epidermal necrolysis: idiosyncratic reaction to drugs]. / Necrólisis epidérmica tóxica: reacción idiosincrática a neurofármacos.

Toxic epidermal necrolysis (NET) and Steven Johnson syndrome (SJS) are infrequent mucocutaneous hypersensitivity reactions with systemic involvement. They are predominantly caused by drugs. We report the case of a patient over 60 years of age who presented with extensive mucocutaneous and ophthalmic injury with hemodynamic failure, associated with the rapid onset of lamotrigine in a short period of time. Although the incidence is low, the mortality rate is high. It requires early suspicious and diagnosis in addition to an interdisciplinary therapeutic approach.

Acute and Chronic Anti-ganglioside Neuropathies: From Theory to Practice in Buenos Aires, Argentina.

BACKGROUND AND AIMS: During the last two decades important advances have been made regarding the knowledge of immunomediated neuropathies, which entitled them to evolve from a theoretical existence to subtype differentiation. Nevertheless, questions regarding antigen topography or antibody's pathogenicity still need to be answer. Moreover, antibody typification is not necessarily available during clinical practice and usually diagnostic decisions or follow-up are done without it. The aim of this study is to raise awareness of the importance of divergent clinical findings in patients with immunomediated neuropathies. METHODS: We present an acute and a chronic case of anti-ganglioside neuropathy immunologically studied with the best anti-ganglioside antibody panel available nowadays in our country along with an update of the current knowledge of these entities. RESULTS: Although there is no consensus regarding the pathogenicity of these antibodies, diverging clinical features (mainly ataxia and ophthalmoparesis) and disease prognosis (as markers of axonal damage) are known to be associated with different antibodies. CONCLUSIONS: Antibody characterization in anti-ganglioside neuropathies is an evolving field, which we believe should periodically updated and minded for patient's diagnosis and follow-up, even if laboratory confirmation is not immediate, if available at all.

A new species of Ceraeochrysa Adams (Neuroptera, Chrysopidae), with a key to the species from Mexico.

The genus Ceraeochrysa Adams is widely distributed in the New World, from southeastern Canada to Argentina, with 15 out of 61 previously known species recorded in Mexico. In this paper, Ceraeochrysa tacanensis sp. nov. is described and illustrated from Volcán Tacaná, Chiapas, and an identification key to Ceraeochrysa species present in Mexico is provided. The new species is similar to others with swollen and darkened posterior branches of the cubital vein, and it can be separated from these other species by an elongate gonapsis extending from the base of the gonosaccus; the gonapsis is slightly upturned, terminating in a rounded apex with dorsal microteeth. Females of the new species have non-distinctive genitalia morphology. However, they can be associated with males of the species by body color pattern, synchrony, and sympatry.

Four new species of Plega Navás, 1928 (Neuroptera: Mantispidae) from Mexico.

Four new species of Plega Navás, 1928 (Mantispidae: Symphrasinae) from Mexico are herein described and illustrated, namely P. mixteca sp. n. from Oaxaca and Jalisco, P. stangei sp. n. from Morelos and Oaxaca, P. sonorae sp. n. from Sonora, and P. spinosa sp. n. from Guerrero, Jalisco, Morelos, Nayarit, Oaxaca, Puebla, and Veracruz. Including these new species, Plega's diversity raises to 17 described species, of which 12 are recorded from Mexico, and one of them, Plega variegata Navás, 1928, is herein proposed as nomen dubium. A taxonomic key to the known species of Plega from Mexico is provided.

Colecistitis hemorrágica: reporte de caso y revisión de la literatura / Hemorrhagic cholecystitis: case report and literature review

Resumen Introducción: La colecistitis hemorrágica es una complicación poco frecuente de la colecistitis aguda con una alta mortalidad. Materiales y Método: Paciente con dolor abdominal en hipocondrio derecho e ictericia. Los exámenes de laboratorio y ultrasonido hepatobiliar mostraron datos sugestivos de colecistitis aguda; durante su estancia hospitalaria presenta deterioro de su estado general, realizándose tomografía computarizada mostrando imágenes sugestivas de colecistitis hemorrágica y hemoperitoneo. Resultados: Laparotomía de urgencia, corroborando los hallazgos tomográficos y resolviéndose satisfactoriamente con la colecistectomía. Discusión: El diagnóstico de colecistitis hemorrágica es difícil ya que sus manifestaciones clínicas de inicio no difieren de la colecistitis aguda, por lo que la sospecha clínica y el adecuado estudio de imagen son importantes para su detección. Conclusión: A pesar que la colecistitis hemorrágica con perforación y hemoperitoneo es una patología muy poco común, de diagnóstico confuso, es importante establecer la realización de una tomografía computarizada abdominal con contraste endovenoso en pacientes con sospecha de colecistitis aguda grave.

Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.

Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel syndrome: a case report.

BACKGROUND: Adult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel's syndrome. Literature describing complications related to this pathology remains scarce. CASE PRESENTATION: A 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed. CONCLUSIONS: We present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.

[Photographic documentation during safe laparoscopic cholecystectomy]. / Documentación fotográfica durante la colecistectomía laparoscópica segura.

INTRODUCTION: Laparoscopic cholecystectomy is the most frequent procedure for the general surgeon. Biliary injury is a concern that must be addressed with the purpose of lowering the rate. The critical view of safety (CVS) is a target of dissection that impulses safety during the procedure. OBJECTIVE: Determine by an ambispective analysis the safety during dissection of laparoscopic cholecystectomy in Hospital Civil de Culiacán (México). METHODS: Descriptive, ambispective, observational, cross-sectional. Patients admitted to the operating room for a laparoscopic cholecystectomy were scored with Doublet photography rating criteria from January 1st 2015 to January 31, 2017. RESULTS: 321 patients were evaluated, 77.9% were female and 22.1% male. The mean age was 45.57 ± 16.17 years. 65.4% had admission diagnosis of cholelithiasis, 24.3% acute cholecystitis, 5.9% chronic cholecystitis, 3.7% hydrocolecist and 0.6% pyocolecist. Surgeries were scored with Doublet photography. The CVS was obtained in 41.4% of the procedures with a statistical significance between a HPB surgeon and a general surgery resident (p ≤ 0.05). CONCLUSION: Recording Doublet photography provides a reliable CVS dissection criterion. It can be easily reproduced during laparoscopic cholecystectomy. The identification of cystic structures adds to the culture of safety during laparoscopic cholecystectomy.

INTRODUCCIÓN: La colecistectomía laparoscópica es la cirugía realizada con más frecuencia. La tasa de lesión en la vía biliar impulsa para implementar métodos de seguridad, como la visión crítica de seguridad (VCS). OBJETIVO: Determinar la documentación fotográfica ambispectiva durante la colecistectomía laparoscópica segura en el Hospital Civil de Culiacán. MÉTODO: Estudio descriptivo, observacional, ambispectivo, transversal, de pacientes sometidos a colecistectomía laparoscópica en el Hospital Civil de Culiacán, evaluados con criterios fotográficos de Doublet para asegurar si la VCS se obtuvo de manera satisfactoria, del 1 de enero de 2015 al 31 de enero de 2017. RESULTADOS: Se analizaron 321 pacientes (77.9% del sexo femenino y 22.1% del sexo masculino), con una edad promedio de 45.57 ± 16.17 años, y diagnóstico de colelitiasis (65.4%), colecistitis aguda (24.3%), colecistitis crónica (5.9%), hidrocolecisto (3.7%) o piocolecisto (0.6%). Los cirujanos realizaron la calificación de las fotografías otorgando puntajes en la vista anterior, posterior y Doublet. Se determinó un 41.4% de VCS satisfactoria mediante análisis Doublet, con diferencia estadísticamente significativa entre las calificaciones del cirujano hepatobiliar y el médico residente (p ≤ 0.05). CONCLUSIONES: La realización de las fotografías en pacientes con registros confiables de la VCS es ideal para la colecistectomía laparoscópica, permitiendo identificar adecuadamente las estructuras císticas y evitar la lesión de vía biliar.

Craneoplastia en deformidad postraumática y postquirúrgica, 18 años de experiencia en el Hospital General de México: una opción reconstructiva segura / Craneoplasty in post-traumatic and postoperative deformity, a 18- year experience at Hospital General de México: a secure reconstructive option

Introducción y Objetivos. Los defectos craneales que llegan a nuestro hospital generalmente son secundarios a trauma o bien a su tratamiento neuroquirúrgico. La craneoplastia no suele ser inmediata, sin embargo el síndrome de trepanación o el deseo del paciente por mejorar su apariencia, son mandatorios para poder realizar la reconstrucción. El material ideal para una craneoplastia debe ser biocompatible, fácil de fabricar y biomecánicamente estable. En nuestro Servicio llevamos a cabo la reconstrucción craneal con una prótesis de metil-metacrilato diseñada mediante estereolitografía, cubierta completamente por un injerto de fascia lata. En nuestra experiencia esta nos brinda resultados predecibles, seguros y satisfactorios para los pacientes. Material y Método. Presentamos nuestra experiencia inicial en el uso de esta técnica a través de un análisis retrospectivo sobre 32 pacientes operados por un equipo multidisciplinario entre enero de 1996 y junio de 2014 en el Hospital General de México Dr. Eduardo Liceaga. Resultados. No tuvimos complicaciones importantes relacionadas con infección, hematoma o seroma. Los resultados estéticos obtenidos fueron de aceptables a buenos. Conclusiones. En esta serie de pacientes usando la técnica descrita, recogimos una tasa de complicaciones muy baja y un excelente grado de satisfacción de los pacientes en el seguimiento a largo plazo (AU)

Background and Objective. The skull defects in our center result from descompressive craniectomy after trauma, bony involvement by tumors or infarction, and the cranioplasty will be mandatory if the patient have the syndrome of the trephined or wish to improve their appearance. The ideal material for cranioplasty there will be biocompatible, simple to manufacture, and biomechanically reliable, at least. In our Department, the skull reconstruction is performed with methylmethacrylate prosthesis, designed by stereolithography, and then covered with an onlay fascia lata tendon graft. In our experience this kind of skull reconstruction has been demonstrated secure, predictable and satisfactory results. Methods. We report our initial experience using this technique with a retrospective analysis of 32 patients operated from January 1996 to June 2014 by a multidisciplinary team in the General Hospital of Mexico Dr. Eduardo Liceaga. Results. There were no significant complications related to infection, hematoma or seroma. The aesthetic results have been considered acceptable, to excellent. Conclusions. In our patient series using this technique we collected an extremely low complication rate and an excellent grade of patient satisfaction on long-term follow up (AU)

DNA-graphene interactions during translocation through nanogaps.

We study how double-stranded DNA translocates through graphene nanogaps. Nanogaps are fabricated with a novel capillary-force induced graphene nanogap formation technique. DNA translocation signatures for nanogaps are qualitatively different from those obtained with circular nanopores, owing to the distinct shape of the gaps discussed here. Translocation time and conductance values vary by ∼ 100%, which we suggest are caused by local gap width variations. We also observe exponentially relaxing current traces. We suggest that slow relaxation of the graphene membrane following DNA translocation may be responsible. We conclude that DNA-graphene interactions are important, and need to be considered for graphene-nanogap based devices. This work further opens up new avenues for direct read of single molecule activitities, and possibly sequencing.

[Acute appendicitis during pregnancy: report of 4 cases]. / Apendicitis aguda durante el embarazo: reporte de 4 casos.

BACKGROUND: Acute appendicitis is the more frequent no obstetric surgical emergency during pregnancy with an incidence of 1 in 1500 pregnancies. The clinical diagnosis is difficult because of the physiological changes of pregnancy itself. If not treated early increases the risk of maternal and fetal morbidity. OBJECTIVE: To describe the diagnosis and treatment of four cases of acute appendicitis during pregnancy. CLINICAL CASE: Four cases of acute appendicitis during pregnancy diagnosed in the period of a month. Gestational age at diagnosis of appendicitis was between 8 and 13 week. All patients underwent laparotomy; three cases were appendicitis phase II and one phase III. The preoperative was managed with indomethacin and ceftriaxone. There were no maternal or obstetric complications. CONCLUSIONS: An early diagnosis and treatment of acute appendicitis during pregnancy, and a multidisciplinary approach between surgeon, obstetrician and anesthesiologist is the basis for success in the management of these patients.

[Giant Amyand hernia]. / Hernia de Amyand gigante.

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1%. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand's hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand’s hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante. / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyands hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Diagnóstico y tratamiento de nódulos de la glándula tiroides / Diagnosis and treatment of the thyroid gland nodules

Se realizó un estudio descriptivo y transversal de 88 pacientes con nódulos de la glándula tiroides, atendidos en el Hospital Oncológico Provincial Conrado Benítez de Santiago de Cuba durante el trienio 2001 - 2003,con vista a determinar los métodos de diagnóstico utilizados y su eficacia, las técnicas quirúrgicas aplicadas y las complicaciones posoperatorias. En sentido general se obtuvo que 64.8 por ciento de las lesiones eran benignas, así como también que entre los procedimientos empleados para diagnosticar los tumores sobresalieron la citología aspirativa con aguja fina y la citología por “impronta” peroperatoria, cuyos resultados fueron fidedignos en 86,3 y 88,7 por ciento, respectivamente. Se ejecutó tiroidectomía total en 74,1 por ciento de los afectados por nódulos malignos y hemitiroidectomía en 78,9 por ciento de los que presentaban tumores benignos. Las complicaciones posoperatorias ocurridas se atribuyeron a lesiones recurrentes de la tiroidectomía total. Se indicó tratamiento con I131 a 60 por ciento de los pacientes con neoplasmas malignos