Iatrogenic Liver Perforation During Liposuction: A Case Report and In-depth Review of Clinical Presentation, Management, and Lessons Learned.

Liposuction is generally recognized as a safe medical procedure. However, it is important to acknowledge the potential for complications during and after the operation. Although rare, the occurrence of iatrogenic liver perforation following liposuction is viewed as a serious complication, necessitating immediate and attentive medical care. We report a case of a 42-year-old female who underwent liposuction and presented with abdominal pain 3 days later. Elevated liver enzymes and imaging revealed an active bile leak from the right liver lobe. Exploratory laparotomy confirmed a penetrating injury, leading to multiple washout surgeries. After a 3-month hospital stay, including intensive care, the patient fully recovered upon discharge following abdominal wound closure. Despite considering liposuction procedures safe due to the associated overall low risk rates, it can lead to life-threatening complications such as hollow viscus or solid organ injury. The treatment for such complications can either be surgical or nonsurgical, depending on the patient's presentation and diagnosis. To promptly identify and address any complication postsurgery, close monitoring of patients postoperatively is necessary.

Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos / Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals

El presente trabajo pretende establecer una guía de actuación consensuada entre anestesiólogos y neurofisiólogos para realizar una monitorización neurofisiológica intraoperatoria efectiva en procedimientos tanto neuroquirúrgicos, como en aquellos en los que existe un riesgo de lesión neurológica funcional. En la primera parte, se describen las principales técnicas utilizadas en la actualidad para la monitorización neurofisiológica intraoperatoria. En segundo lugar, se describen los factores anestésicos y no anestésicos que pueden afectar al registro eléctrico de las estructuras del sistema nervioso. Posteriormente, se analizan los efectos adversos de las técnicas más comunes derivados de su utilización. Y, por último, se describen las diferentes pautas a seguir tras la aparición de los diferentes eventos clínicos intraoperatorios.(AU)

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.(AU)

Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. / Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos.

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.

A new technique of pedicle screw placement with the use of sequential multilevel navigation templates based on patient-specific 3D CT reconstruction model: applicability in spine deformity.

INTRODUCTION: The technique of placement of pedicle screws has gradually improved, but even misplacement observed in 1.2 to 20% of cases, have appeared techniques fluoroscopic, tomographic and electromagnetic navigation, which led it to 1.3 to 4.3%, but nevertheless they are expensive and complex technologies. Present technique pedicle screw placement by using templates with a modification in the art, performing tomography and reconstruction in the same surgical position and with the templates of 3 or more levels. METHODS: Five cases of idiopathic scoliosis were performed, with correction and instrumentation with pedicular screws, where a three-dimensional model of the spine was performed with a tomography in a surgical position, whose images were exported to a 3D printer to reconstruct the desired trajectory of the screws in a template using cylinders resting on the inverse surface of the vertebrae. The direction of the screw was planned in the center of the pedicle and parallel to the upper platform of the vertebra. Each template was of several levels and transoperative X-rays were not used. RESULTS: Under electrophysiologic monitoring transoperative «red alerts¼ were not reported, the placement of the screws in postoperative CT scan was evaluated, showing a standard deviation in placement of 1.9 and 2.2 mm on the right and left respectively pedicles, with respect to their planning. DISCUSSION: This technique is simple and safe, besides not requiring great technology, its use is suggested in beginner spine surgeons and in severe deformities, it can be performed in any hospital where spinal surgery is performed.

INTRODUCCIÓN: La técnica de colocación de tornillos transpediculares ha mejorado paulatinamente, a pesar de ello, la mala colocación oscila entre 1.2 al 20% de los casos; han surgido técnicas de navegación asistidas por flouroscopía, tomografía y resonancia magnética mejorando el índice de falla al 1.3-4.3%. La presente técnica de colocación utiliza plantillas con la modificación de que la tomografía y la reconstrucción son realizadas con el paciente en la posición quirúrgica, además que las plantillas abarcan tres o más niveles. MÉTODOS: Se presentan cinco casos de escoliosis idiopática tratados con instrumentación y colocación de tornillos transpediculares donde se generó un modelo tridimensional de la columna en posición quirúrgica; las imágenes fueron exportadas a una impresora 3-D para reconstruir la trayectoria apropiada de los tornillos, la dirección de éstos fue planeada tomando de referencia el centro del pedículo y paralela a la plataforma superior de la vértebra. Cada plantilla consta de diferentes niveles y no se requirió del uso de rayos X trans­operatorios. RESULTADOS: Bajo monitoreo electrofisiológico transquirúrgico no se reportó ninguna «alerta roja¼; la evaluación postoperatoria por tomografía de la colocación de los tornillos mostró una desviación estándar de 1.9 y 2.2 mm tanto a la derecha y a la izquierda, respectivamente, de acuerdo con lo planeado. DISCUSIÓN: La técnica es simple y segura, no requiere de mucho despliegue tecnológico, se sugiere su uso para los cirujanos de columna con poca experiencia y para deformidades severas; consideramos que puede desarrollarse en cualquier hospital donde se realice cirugía de columna.

Demographic and clinical characteristics of patients with spinal cord injury: a single hospital-based study.

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the demographic and clinical characteristics of patients diagnosed with spinal cord injury (SCI) admitted to a single center. SETTING: Single center study, México. METHODS: This study reviewed 433 patients with SCI. Data were extracted from medical records and retrospectively reviewed. RESULTS: A total of 433 patients with a diagnosis of SCI were included in the analysis. Of these, 346 (79.9%) had traumatic SCI (TSCI) and 87 (20.1%) had non-traumatic SCI (NTSCI). The principal causes of traumatic TSCI were motor vehicle accidents in 150 patients (43.4%), falls in 107 patients (30.9%) and a result of firearms in 58 patients (16.8%). Tumoral cord compression was the main cause of NTSCI in 50 patients (57.4%), followed by degenerative disease-causing myelopathy in 17 patients (19.5%). The proportion of patients affected with NTSCI was significantly lower, 29.9 vs 79.1% (P=0.0001), the age of patients was higher 53.9 vs 37.8 (P<0.002) and SCI was less severe, AIS D 41.33 vs 9.5% (P=0.0001) compared with the TSCI group. CONCLUSIONS: The demographic profiles of patients with TSCI and NTSCI differ in terms of proportion of total SCIs, patient age, male:female ratio and incomplete vs complete injury. The most common etiology of TSCI was motor vehicle accidents (43.4%), and neurological lesions were complete in 62.7% of patients. The most common etiology of NTSCI was tumoral spinal lesions (57.4%), and lesions were incomplete in 75.8% of patients.

Consciousness, cognition and brain networks: New perspectives. / Consciencia, cognición y redes neuronales: nuevas perspectivas.

A detailed analysis of the literature on consciousness and cognition mechanisms based on the neural networks theory is presented. The immune and inflammatory response to the anesthetic-surgical procedure induces modulation of neuronal plasticity by influencing higher cognitive functions. Anesthetic drugs can cause unconsciousness, producing a functional disruption of cortical and thalamic cortical integration complex. The external and internal perceptions are processed through an intricate network of neural connections, involving the higher nervous activity centers, especially the cerebral cortex. This requires an integrated model, formed by neural networks and their interactions with highly specialized regions, through large-scale networks, which are distributed throughout the brain collecting information flow of these perceptions. Functional and effective connectivity between large-scale networks, are essential for consciousness, unconsciousness and cognition. It is what is called the "human connectome" or map neural networks.

[Acute abdominal pain in elderly patients evaluated in the emergency department at a tertiary level]. / Dolor abdominal agudo en pacientes geriátricos evaluados en el servicio de urgencias en un hospital de tercer nivel.

BACKGROUND: Life expectancy in México has increased in the last decades with a remarkable increase in geriatric population. Acute abdominal pain (AAP) in elderly people compared with young people has different clinical presentation because of the concomitant chronic diseases, the use of medications, history of abdominal surgeries and decrease in perception of pain and immunity. OBJECTIVE: To know the cause and associated mortality of acute abdominal pain in geriatric patients who attend the emergency room. METHODS: Geriatric patients' files with acute abdominal pain admitted from January 2004 to December 2008 were retrospectively reviewed. Age, gender, presence of chronic diseases, use of medications, history of surgical procedures, definitive diagnosis causative of the symptoms and the associated mortality were recorded. RESULTS: 17 524 patients were admitted, of whom 324 (1.8%) were geriatric patients with AAP: 110 were men (36.9) and 214 were women (66%), with a mean age of 78 years (range 60 to 102 years). The most common causes of AAP were acute cholecystitis in 49 patients (15.1%), irritable bowel syndrome in 42 (12.9%), ulcerative syndrome in 40 (12.3%), intestinal obstruction in 35 (10.8%) and diverticulitis in 23 (10.8%). Nine patients died (2.7%). CONCLUSIONS: In our hospital the most common cause of AAP in geriatric patients is related to biliary disease followed by functional gastrointestinal disorder and ulcerative syndrome. Mortality is low.

Learning and orientation to odor in the bug Rhodnius prolixus Stal 1859 under laboratory conditions.

Two experiments are described investigating learning and orientation in the triatomine Rhodnius prolixus. In experiment 1, Pavlovian conditioning was investigated. The experiment differed from our previous work in that the intensity of the conditioned and unconditioned stimuli were reduced and the number of training trials increased. Once again, no evidence for Pavlovian conditioning was found. In experiment 2, an "orientation arena" was developed in which the orientation of R. prolixus to a human forearm was investigated when an area of the forearm was impregnated with the odor of ruda or almizcle compared to a forearm with no odor. The various paths of the animal from the bottom of the arena until ascending and piercing the forearm, located at the top of the arena, was scored using a grid system and videotaped. The results indicated that under the no odor condition R. prolixus predominately travels in a straight line from the bottom of the arena to the top where the forearm is located. In contrast, the most variable number of paths occurred with exposure to ruda. Exposure to almizcle elicited straight line paths but other paths were evident, although not as variable as that observed with ruda.

Índice de defecación y éxito reproductivo de Triatoma maculata (Hemiptera: Reduviidae)en condiciones de laboratorio / Defecation index and reproductive success of Triatoma maculata (Hemiptera: Reduviidae) under laboratory conditions

Se estudió el comportamiento reproductivo y de defecación de Triatoma maculata (Erichson 1848)alimentando artificialmente con sangre humana.Los estadios II y III mostraron mayor frecuencia de defecaciones (ID=0.6 n=40),el estadio V no alcanzó la diferenciación sexual, la fertilidad fue 55%(n=865),fecundidad 8 huevos/hembra/semana (n=26),22 días de desarrollo embrionario (n=477),longevidad de hembras 51 días (n=26),el tiempo intermuda aumenta progresivamente desde 35 días en el estadio I hasta 46 días en el estadio IV,el porcentaje de muda varió desde 0%en el estadio V hasta 63%en el estadio III,la mortalidad varió desde 8%en el estadio III hasta 100%en el estadio V (n=40).Los resultados del presente trabajo aportan evidencias que explican la menor capacidad vectorial y la baja densidad de T.maculata en el domicilio humano

The reproductive and defecating behavior of Triatoma maculata (Erichson 1848)was studied on animals from an university culture in Venezuela.This species does not reach the importance of Rhodnius prolixus Stal 1859 as Chagas disease vector in Venezuela.This study addressed the role of defecating frequency,an index of how dangerous the animals are for the human population,and its relationship with why T.maculata is a less important vector than R.prolixus .Human blood was fed to the insects through an artificial feeding device.The 2nd and 3rd instar nymphs defecated more frequently (Id=0.6,n=40),and our Vth instar nymphs did not complete sexual differentiation.Fertility was 55%(n=865)and fecundity 8 eggs/female/week (n=26). Egg incubation lasted 22 days (n=477).Female longevity was 51 days (n=26).Intermould time grew progressively from 35 days for 1st to 40 days for 4th instar nymphs (n=40).Mould percentage varied from 0% for Vth to 63%for 3rd instar nymphs.Mortality varied from 8% for 3rd to 100% for Vth instar nymphs.These results support evidences explaining the lesser vectorial capacity and low density of T.maculata in human domiciles, including reduced reproduction and defecation when the animal feeds on human blood

[Defecation index and reproductive success of Triatoma maculata (Hemiptera: Reduviidae) under laboratory conditions]. / Indice de defecación y éxito reproductivo de Triatoma maculata (Hemiptera: Reduviidae) en condiciones de laboratorio.

The reproductive and defecating behavior of Triatoma maculata (Erichson 1848) was studied on animals from an university culture in Venezuela. This species does not reach the importance of Rhodnius prolixus Stal 1859 as Chagas disease vector in Venezuela. This study addressed the role of defecating frequency, an index of how dangerous the animals are for the human population, and its relationship with why T. maculata is a less important vector than R. prolixus. Human blood was fed to the insects through an artificial feeding device. The 2nd and 3rd instar nymphs defecated more frequently (Id= 0.6, n=40), and our Vth instar nymphs did not complete sexual differentiation. Fertility was 55% (n=865) and fecundity 8 eggs/female/week (n=26). Egg incubation lasted 22 days (n=477). Female longevity was 51 days (n=26). Intermould time grew progressively from 35 days for 1st to 40 days for 4th instar nymphs (n=40). Mould percentage varied from 0% for Vth to 63% for 3rd instar nymphs. Mortality varied from 8% for 3rd to 100% for Vth instar nymphs. These results support evidences explaining the lesser vectorial capacity and low density of T. maculata in human domiciles, including reduced reproduction and defecation when the animal feeds on human blood.

Alimentación y defecación en triatominos del género Rhodnius (Hemiptera: Reduviidae) alimentados con sangre humana / Feeding and defecation of Rhodnius (hemiptera: Reduviidae) fed human blood

Se estudió el comportamiento alimenticio y de defecación de Rhodnius prolixus Stal, 1859, R. robustus Larrousse, 1927, R. neivai Lent, 1953 y R. pictipes Stal, 1872 alimentados artificialmente con sangre humana en condiciones de laboratorio. La ninfa I de todas las especies no defecaron en la primera media hora después de haber iniciado la ingesta. R. pictipes no se acercó a picar en el alimentador artificial aunque si lo hizo cuando el alimento se ofreció directamente sobre el cuerpo humano. Las ninfas y adultos de R. prolixus mostraron índices de defecación (ID) superiores a los correspondientes de las otras especies, y la ninfa III presentó el mayor ID=1.62. La mayoría de individuos de todos los estadíos de desarrollo aceptaron el alimento en un tiempo entre 0 y 3 min y se alimentaron en menos de 15 minutos.

Efecto de la alimentación con sangre humana sobre la fecundidad, fertilidad y ciclo biológico de Rhodnius prolixus (Hemiptera: Reduviidae) / Effect of human blood feeding on the fecundity, fertility and biological cycle of Rhodnius prolixus (Hemiptera: Reduviidae)

Se observó el efecto de diferentes fracciones de sangre humana sobre la ovipostura (fecundidad), la eclosión (fertilidad) y el ciclo biológico de Rhodnius prolixus Stal 1859 utilizando un alimentador artificial. En los ejemplares alimentados con sangre de hombre, la fecundidad fue mayor que en los alimentados con sangre de mujer. No hubo diferencia significativa en la fertilidad relacionada con la procedencia de las fracciones. En cada estadio se estimaron los tiempos de permanencia y el número de ingestas necesarias para mudar al siguiente estadio ninfal. Los animales alimentados sólo con plasma no completaron el desarrollo ninfal, mientras que los alimentados sólo con glóbulos rojos se desarrollaron hasta el tercer estadio. El ciclo de vida se completó en 129 días en los individuos alimentados con sangre sin fraccionar.

[Feeding and defecation of Rhodnius (hemiptera: Reduviidae) fed human blood]. / Alimentación y defecación en triatominos del género Rhodnius (Hemiptera: Reduviidae) alimentados con sangre humana.

Feeding and defecation behavior of Rhodnius prolixus Stal, 1859, R. robustus Larrousse, 1927, R. neivai Lent, 1953 and R. pictipes Stal, 1872, artificially fed on human blood, were studied under laboratory conditions. In all species, first instar nymphs did not defecate in the first 30 minutes after feeding. R. pictipes did not accept artificial feeding but fed directly on humans. Nymph and adult R. prolixus had a higher defecation index (DI) than other species; third instar nymphs had the highest DI = 1.62. In all instars, most individuals accepted the food in 3 Pounds minutes and finished feeding in less than 15 minutes.

[Effect of human blood feeding on the fecundity, fertility and biological cycle of Rhodnius prolixus (Hemiptera: Reduviidae)]. / Efecto de la alimentación con sangre humana sobre la fecundidad, fertilidad y ciclo biológico de Rhodnius prolixus (Hemiptera: Reduviidae).

The effect of several human blood fractions artificially fed to Rhodnius prolixus Stal 1859 on oviposture (fecundity), egg-hatching (fertility) and life cycle was observed. Specimens fed on man's blood were more fecund than those fed with woman's blood. There were no significant differences in fertility related to host sex. The nymphal development time and number of feedings to molt to the following instar were estimated. Animals fed only on blood plasm did not finish nymphal development, while those fed only blood red cells ended their life cycle in the third nymphal instar. Total life cycle lasts 129 days in individuals fed with whole blood.

The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer.

The efficacy of a relaxation technique involving deep breathing, muscle relaxation, and imagery was tested as a nursing intervention for the promotion of comfort and pain relief in hospitalized oncology patients. The intervention was implemented in accordance with Orem's self-care approach to nursing practice. Sixty-seven new admissions to an oncology ward were randomly assigned to receive relaxation training by audio tapes, live relaxation training by nurses, or no relaxation training. Relaxation training was conducted twice weekly over a period of three weeks. All subjects were pretested and post-tested with the McGill Pain Questionnaire and Visual Analogue Scale for pain. Analgesic medication was monitored throughout the study. Data analysis showed significant reductions in subjective pain ratings by subjects receiving relaxation training. There was also a significant reduction in non-opiate p.r.n. analgesic intake which suggested a reduced incidence of breakthrough pain.

Tegumental Ca-stimulated adenosine triphosphatase activity in adult Schistosoma mansoni worms.

A Ca-stimulated ATPase activity (pH 9.5) associated with the tegumental membrane enriched (TME) fraction of Schistosoma mansoni adults was partially inhibited by NAP-taurine or by increasing concentrations of chlorpromazine; endogenous calmodulin was found associated with the TME fraction. A similar activity (pH 8.6) was histochemically visualized within the tegument of fixed worms on the cytoplasmic leaflet of both the double surface membrane and the basement membrane; this reaction was inhibited by 1 microM chlorpromazine and it was also observed on the inner side of double membrane vesicles present in the TME fraction. No ATPase activity could be seen at alkaline pH with added Mg or Na/K ions. Without ATP, the addition of external Ca to the fixed worms induced the appearance of lead precipitates on the tegumental discoid bodies; this reaction was inhibited by molybdate and not by chlorpromazine. The intrategumentary regulation of calcium by the systems described and the possible use of phenothiazines against schistosomes are discussed.

[Microecological characterization of parasitic nematoda present in goats of arid zones of Venezuela]. / Caracterización microecologica de nemátodos parásitos presentes en caprinos de zonas áridas de Venezuela.

Goats from the Venezuelan northern arid zones were found infested by the following nematodes: Haemonchus contortus, Trichostrongylus axei, T. colubriformis, Cooperia curticei, Oesophagostomum columbianum, Skrjabinema ovis y Trichuris globulosa. The Shannon-Weaver index of diversity values oscillated between 0.045 and 1.73 bits (means = 1.16 +/- 0.24 bits). The maximum value of montly diversity ranged from 1 to 2.80 bits (means = 2.49 +/- 0.28 bits) and the equitability ranged from 0.045 to 0.67 (means = 0.44 +/- 0.09). Parasitic associations were found among 1) T. axei, T. colubriformis and H. contortus, 2) T. colubriformis, H. contortus and O. columbianum and 3) T. colubriformis, S. ovis and T. globulosa. The above results suggest that in months when the diversity index is close to the maximum value and the equitability index is near unity, wide spectrum antihelmintic treatment should be used for poly-parasitized animals.

[Comparison between the communities of parasitic nematoda of sheep and goats bred in arid zones of Venezuela]. / Comparación entre las comunidades de nemátodos parásitos de ovinos y caprinos criados en zonas áridas de Venezuela.

Under the studied conditions, the structure and composition of community of parasitic nematodes observed in both sheeps and goats, is similar (rS = 0.90 P less than or equal to 0.05 and CSS = 93.33%), the Shannon-Weaver index of diversity was 1.23 +/- 0.15 bits and 1.15 +/- 0.24 bits for sheeps and goats, respectively. The equitability index resulted in 0.49 +/- 0.06 for sheep-nematodes and 0.44 +/- 0.09 for goats-nematodes. However, no significant difference was observed when the means of these indexes, were compared. Not withstanding, a greater homogenity was observed in the ovine parasitic nematodes.