Episiotomía estado del arte. Una muestra conductual en los partos del Hospital Universitario Hernando Moncaleano Perdomo / Episiotomy state of the art. A sample in the deliveries of the Hernando Moncaleano Perdomo Hospital Universitario

Resumen La episiotomía es una intervención común usada en las salas de partos. Se define como la realización un tipo de intervención quirúrgica en el periné́ que pretende facilitar la expulsión del producto ampliando el canal blando del parto. Este tiene unas indicaciones para su realización. El objetivo de nuestro estudio fue evaluar las razones para la realización de episiotomía en el HUHMP, analizar si esta se realiza según las indicaciones maternas-fetales, evaluar cuanto la implementación de una episiotomía selectiva puede proteger contra las laceraciones perineales y realizar una revisión de la literatura relevante y actual en este tema. El total de pacientes fue 214 en el periodo de Agosto, Septiembre y Octubre DEL 2016. De las cuales 103 (48.13%) fueron primigestantes, y las no primigestantes fueron 111(51.86%). En cuanto a la presencia de desgarros en las primigestantes se encontró desgarro grado 1 (17.51%), desgarro grado 2 ( 21.63%) desgarro grado 3 (0%) y desgarro grado 4 ( 1.03%), sin desgarro (39.14%),a este grupo de pacientes se les realizo episiotomía a (25.75%). En las no primigestantes fue desgarro grado 1 (32.19%), desgarro grado 2 ( 14.43%) desgarro grado 3 (0%) y desgarro grado 4 ( 0%), sin desgarro (68.82%),a este grupo de pacientes se les realizo episiotomía a (7.77%) Cuando se realizaron episiotomías se tuvieron como indicación periné corto y poca distensibilidad con un 19.3%, acortamiento del periodo expulsivo 16%, prevención de desgarro y acortamiento de trabajo de parto 6.4%, primigestante 3.2% Y en el 58% de las pacientes en quienes se realizó episiotomía no tenían indicación descrita.

Abstract Episiotomy is a common intervention used in maternity ward. It is defined as a type of surgery in the perineum intended to facilitate the expulsion of the product extending the birth canal. This has some indications for its realization. The objetive of our study was to evaluate the episiotomy reasons in HUHMP, analyze whether this is done by maternal-fetal indications, the assess the implementation of a selective episiotomy may protect against lacerations and a review of the relevant and current literature on this subject. The total was of 214 patients in the period of August, September and October 2016. Of which 103 (48.13%) were primigravidae, and non primigravidae were 111 (51.86%). In the primigravidae group the tearing grade 1 (17.51%), tearing grade 2 (21.63%) tearing Grade 3 (0%) and tear Grade 4 (1.03%), without tearing (39.14%); this group of Patients underwent episiotomy (25.75%). In non primigravidae I was tear grade 1 (32.19%), tear grade 2 (14.43%) tearing Grade 3 (0%) and tear Grade 4 (0%), without tearing (68.82%), this group of Patients Were episiotomy Performed (7.77%) When episiotomies were performed were taken as indication Short perineum and poorly compliant con un 19,3%, shortening the period expulsive 16%, prevention tear and shortening of Labor 6.4%, 3.2% primiparousAnd in 58% of Patients Who episiotomy was performed in they had no indication described

Correction to: PANLAR consensus statement on biosimilars.

The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

Diagnóstico no invasivo de amiloidosis cardiaca por transtirretina. Caso clínico / Non-invasive diagnosis of cardiac amyloidosis due to transthyretin. Case report

La amiloidosis cardiaca por transtirretina se considera en la actualidad la forma más frecuente de amiloidosis cardiaca y su incidencia está aumentando gracias al avance de las técnicas de diagnóstico por imagen. Recientemente se han publicado unos criterios de diagnóstico no invasivo para esta entidad, y se están desarrollando nuevos fármacos para el tratamiento específico de este tipo de amiloidosis cardiaca. Por ello, la amiloidosis cardiaca por transtirretina podría pasar de ser una enfermedad rara a frecuente, y de incurable a potencialmente tratable. Presentamos el caso de un varón de 80 años diagnosticado de amiloidosis cardiaca mediante gammagrafía con 99mTc dicarboxipropano difosfonato (99mTc-DPD) según los nuevos criterios de diagnóstico no invasivo

Amyloidosis due to deposits of transthyretin (ATTR) is currently considered the most frequent form of cardiac amyloidosis and its incidence is increasing thanks to the advances in diagnostic imaging techniques. Some non-invasive diagnostic criteria have recently been published on this entity that due to the development of new drugs for the specific treatment of cardiac ATTR, have prognostic and therapeutic implications. That is why cardiac ATTR could cease to be a rare disease and become a frequent one, and become potentially treatable instead of incurable. We present the case of an 80-year-old male diagnosed with non-hereditary cardiac ATTR by means of gammagraphy with 99mTc diphosfonate scintigraphy (99mTc-DPD) following the new criteria of non-invasive diagnosis

[Non-invasive diagnosis of cardiac amyloidosis due to transthyretin. Case report]. / Diagnóstico no invasivo de amiloidosis cardiaca por transtirretina. Caso clínico.

Amyloidosis due to deposits of transthyretin (ATTR) is currently considered the most frequent form of cardiac amyloidosis and its incidence is increasing thanks to the advances in diagnostic imaging techniques. Some non-invasive diagnostic criteria have recently been published on this entity that due to the development of new drugs for the specific treatment of cardiac ATTR, have prognostic and therapeutic implications. That is why cardiac ATTR could cease to be a rare disease and become a frequent one, and become potentially treatable instead of incurable. We present the case of an 80-year-old male diagnosed with non-hereditary cardiac ATTR by means of gammagraphy with 99mTc diphosfonate scintigraphy (99mTc-DPD) following the new criteria of non-invasive diagnosis.

Use of Social Media and an Online Survey to Discuss Complex Reconstructive Surgery: A Case of Upper Lip Reconstruction with 402 Responses from International Microsurgeons.

BACKGROUND: The best reconstructive strategy for upper lip defects is still in debate. The purpose of this study was to analyze the decisions made by international microsurgeons, who were participated through online questionnaire, distributed by email and social media network. MATERIALS AND METHODS: A case of a two-thirds upper lip oncologic defect was presented via an online questionnaire and 402 microsurgeons replied their treatment options. The data were then analyzed according to the geographic area, microsurgical fellowship, seniority, and subspecialty. All the data were analyzed using SPSS 22. RESULTS: A total of 27.7% of microsurgeons chose a free flap, while 72.3% chose a local/pedicle flap as their preferred method for reconstruction. The most common choice of free and local/pedicle flaps was radial forearm (73.6%) and Abbé (36.2%), respectively. The microsurgeons in Europe preferred local/pedicle flaps than free flap when compared with Middle/South America, Asia-Pacific, Africa and South Asia/Middle East (11.6% versus 50%, 43.4%, 29.3% and 27.3%, respectively, multivariant p < 0.05). The microsurgeons with microsurgical fellowships preferred to use free flaps (32.9% versus 17.5%, multivariant p = 0.021). There was no difference for the seniority and specialty of the microsurgeons. CONCLUSIONS: The online questionnaire is valuable and feasible for obtaining experts' opinions. This study provides a current global overview of surgical preferences for this common complicated clinical scenario.

Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches.

AIM: Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on LN yield has not been well explored. METHOD: This is a retrospective study of right colectomy (RC) for cancer at a single institution from 2012 to 2014. Exclusion criteria were previous colectomy and emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the LN to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude Stage IV cancers and to analyse groups on an 'as-treated' basis. RESULTS: We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) right colectomies. O-RC was more commonly performed in women with metastatic disease. The mean LN yield was 28, 29 and 34 in O-RC, L-RC and R-RC, respectively; the respective mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield than the other approaches (P < 0.01), and a higher LN-LSS ratio than O-RC (P < 0.01). These findings were unchanged in sensitivity analyses. CONCLUSION: Robotic right colectomy improves LN yield and the LN-LSS ratio, which may reflect better mesocolic excision. The effect of these findings on survival requires further investigation.

Incisional hernias after laparoscopic and robotic right colectomy.

PURPOSE: Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies. METHODS: This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH. RESULTS: 276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03). CONCLUSIONS: This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.

Determinantes sociales de la salud asociados con la calidad de vida en personas con discapacidad secundaria a enfermedad vascular cerebral / Social determinants of health associated with the quality of life in people with disabilities secondary to cerebral vascular disease

La enfermedad vascular cerebral (EVC) es un trastorno de la circulación sanguínea cerebral. Se considera un problema de salud pública a nivel mundial ya que se encuentra dentro de las principales causas de muerte y la primera de discapacidad. El impacto de la EVC en la vida diaria de las personas que la padecen puede evaluarse a través del nivel de calidad de vida relacionada con la salud, sin embargo existen factores que la determinan aún más; a éstos se les conoce como Determinantes Sociales de la Salud. El objetivo de este estudio fue analizar el nivel de calidad de vida relacionada con la salud y su asociación con algunos determinantes sociales de la salud. Metodología: Estudio observacional, transversal, prolectivo, descriptivo. Muestra no aleatorizada de 121 personas que presentaron evento vascular cerebral, sin afasia o déficit auditivo severo, con puntuación <4 en Test PFEIFFER, que contestaron la encuesta de los Determinantes Sociales de la Salud y el instrumento "perfil de consecuencias de la enfermedad adaptada a la enfermedad vascular cerebral" (SIP-30). Con los resultados obtenidos se conformó una base de datos en el programa de SPSS y se realizaron análisis descriptivos e inferenciales. Resultados: La principal discapacidad que se presentó fue de tipo motriz seguida del lenguaje, el 54% de la muestra estudiada no reingresó a su vida laboral y el 68% tenía más de 12 meses de haber presentado la EVC. Se observó el nivel de calidad de vida de la siguiente manera: alta en 36%, media 33% y baja en el 31% de la muestra. Algunos de los principales determinantes sociales de la salud relacionados con la calidad de vida fueron: Lugar de residencia con p<0.005, situación laboral p<0.05, tiempo transcurrido del evento vascular p<0.05, número de discapacidades p<0.05, nivel educativo p<0.05. RM=0.371, IC95% 0.0134-1.030 en la situación laboral. Conclusiones: Evaluar los determinantes sociales de la salud y el nivel de calidad de vida de las personas con discapacidad secundaria a un EVC, permite al profesional de enfermería coadyuvar en su cuidado dentro de su propio contexto y realidad además de contribuir a la creación de políticas públicas de salud.

The cerebrovascular disease is considered a global public health problem because it is one of the principal causes of death, and the first one of disabilities. The impact of the cerebrovascular disease on the person's daily life can be readily assessed by the level of health-related quality of life; however, a broader assessment can be achieved through the Social Determinants of Health. The objective of this study was to analyze the level of health-related quality of life and identify its associations with some of the Social Determinants of Health. Methodology: This is an observational, transversal and descriptive study. The sample was not randomized and included 121 persons who had suffered a cerebrovascular accident which did not result in aphasia or severe auditory deficits, who had a score of less than 4 in the PFEIFFER test, and who answered to the Social Determinants of Health survey and the Sickness Impact Profile (SA-SIP30) instrument. With the obtained results, an SPSS database was generated and descriptive and inferential analyses were performed. Results: The main disabilities found were motor-related ones followed by languagerelated ones. Sixty five persons (54% approx.) in the sample did not return to their working lives. Eighty two persons (68% approx.) in the sample had 12 months or more of having suffered the cerebrovascular accident. The level of health-related quality of life was observed as follows: high in approximately 36% and low in approximately 31% of the sample. Some of the main Social Determinants of Health associated with the health-related quality of life were: place of residency: p<0.005; working situation: p<0.05; elapsed time since the cerebrovascular accident: p<0.05; number of disabilities: p<0.05; education level: p<0.05. MR=0.371, CI 95% 0.0134-1.030 in the working situation determinant. Conclusions: Assessing the Social Determinants of Heath and the health-related level of quality life among persons with secondary disabilities due to cerebrovascular accidents, allows the nursing staff, to better provide adequate care in the context and reality of these persons, and also to contribute to the development of the corresponding public health policies.

Ascariasis as cause of intestinal occlusion and concurrent appendicitis.

Intestinal occlusion by ascariasis is a commonly seen socio-economic status low, is associated with poor sanitary hygiene. It is rare to see a case with both intestinal occlusion and appendicitis at the same time, as described in this report.

Síndrome de Kounis: una posibilidad a tener en cuenta como causa de muerte súbita cardiaca / Kounis syndrome: a possibility to be considered as a cause of sudden cardiac death

El llamado síndrome miocárdico alérgico, angina alérgica o síndrome de Kounis, se define como la aparición de un síndrome coronario agudo por vasoespasmo secundario a la activación de mastocitos y células inflamatorias interrelacionadas que se produce en las reacciones de hipersensibilidad, anafilácticas y anafilactoides. Presentamos un caso de muerte súbita en un adulto joven compatible con un síndrome de Kounis, donde el estudio histopatológico demuestra patología asmática y una trombosis en la arteria coronaria descendente anterior sobre una placa erosionada con numerosos eosinófilos y mastocitos en el trombo, en la placa subyacente, en la pared muscular y en la adventicia. La entrevista familiar posterior confirmó el antecedente de atopia y una clínica previa al fallecimiento compatible con un episodio asmático. Como dicen muchos expertos, el Síndrome de Kounis no es una enfermedad rara, pero sí es una enfermedad raramente diagnosticada. Debemos tenerla presente y descartarla ante una muerte súbita en el contexto de una reacción alérgica o de antecedentes de atopia, alergia o asma alérgico (AU)

Kounis syndrome has been defined as the concurrence of an acute coronary syndromes with allergic or hypersensitivity as well as with anaphylactic or anaphylactoid reactions. The main pathophysiological mechanism is the vasospasm of epicardial coronary arteries due to increased inflammatory mediators that are released during the underlaying allergic events. We present a case of sudden death in an atopic young adult with histopathological findings of asthma and thrombosis in left anterior descending coronary artery with presence of eosinophils and mast cell. Kounis syndrome is not a rare disease but is a rarely diagnosed condition which should always be kept in mind when dealing with a cardiac sudden death with clinical history of atopy or allergy or in a context of allergic reactions (AU)

Resultados a corto plazo del tratamiento con 131I en pacientes con bocio multinodular: influencia del grado de hipertiroidismo asociado y otras variables / Short-term results of treatment with 131I in patients with multinodular goiter: effect of the associated degree of hyperthyroidism and other variables

Objetivo. Evaluar la efectividad del tratamiento con radioyodo y la incidencia de hipotiroidismo posterior en pacientes con hipertiroidismo subclínico o hipertiroidismo clínico asociado a bocio multinodular (BMN). Métodos. Estudio retrospectivo de 69 pacientes consecutivos con BMN tratados con 131I, con una dosis fija ponderada de 16 mCi (592 MBq), durante el año 2008 y seguidos durante seis meses. Se clasificaron en dos grupos: hipertiroidismo subclínico e hipertiroidismo clínico. Comparamos la tasa de éxito y la incidencia de hipotiroidismo. Resultados. En el 82,09% de los pacientes se corrigió la disfunción tiroidea; entre los pacientes con hipertiroidismo clínico la proporción fue del 100% y con hipertiroidismo subclínico del 78,13% (p=0,105). La incidencia global de hipotiroidismo fue de 16,42%; 25,00% entre los que presentaban hipertiroidismo clínico y 14,55% entre los hipertiroidismos subclínicos (p=0,400). No se encontraron diferencias estadísticamente significativas al analizar los resultados según el grado de descenso de TSH en los pacientes con hipertiroidismo subclínico. Siete individuos presentaron anticuerpos antiperoxidasa tiroidea (anti-TPO) antes del tratamiento; la incidencia de hipotiroidismo fue superior en ellos (57,14% vs 11,67%; p=0,011). La prevalencia de arritmias cardiacas fue cuatro veces mayor en el grupo de hipertiroidismo clínico. El tratamiento previo con tiamazol afectó de manera positiva a los resultados. Conclusiones. Una dosis fija ponderada de 131I es altamente efectiva y segura para el control del hipertiroidismo clínico y subclínico asociado al BMN. Los pacientes con anticuerpos anti-TPO positivos parecen tener un elevado riesgo de desarrollar hipotiroidismo postyodo(AU)

Objective. To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG). Methods. A retrospective study of 69 consecutive patients treated with 131I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism. Results. The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome. Conclusions. A single fixed weighted dose of 131I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism(AU)

[Short-term results of treatment with 131I in patients with multinodular goiter: effect of the associated degree of hyperthyroidism and other variables]. / Resultados a corto plazo del tratamiento con 131I en pacientes con bocio multinodular: influencia del grado de hipertiroidismo asociado y otras variables.

OBJECTIVE: To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG). METHODS: A retrospective study of 69 consecutive patients treated with (131)I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism. RESULTS: The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome. CONCLUSIONS: A single fixed weighted dose of (131)I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism.

Sarcoidosis ósea. Hallazgos en la exploración con citrato de Galio / Sarcoidosis of bone. Findings in the Gallium citrate examination

Las lesiones óseas en la sarcoidosis son muy poco frecuentes y aparecen entre el 3–9% de los casos. Cuando se producen, son más frecuentes en los pequeños huesos de las manos y los pies que en los huesos largos, las vértebras o el cráneo. Presentamos el caso de un paciente con sarcoidosis con múltiples adenopatías y lesiones de la piel y óseas, así como los hallazgos gammagráficos(AU)

Sarcoidosis of bone lesions are rare, with an overall incidence of 3–9% of the cases. When they do occur, they are more frequent in the small bones of hands and feet than in long bones, spine or skull. We report a case of a male patient with sarcoidosis with multiple enlarged lymph nodes, skin and bone lesions, and the scintigraphic findings(AU)

[Sarcoidosis of bone. Findings in the Gallium citrate examination]. / Sarcoidosis ósea. Hallazgos en la exploración con citrato de Galio.

Sarcoidosis of bone lesions are rare, with an overall incidence of 3-9% of the cases. When they do occur, they are more frequent in the small bones of hands and feet than in long bones, spine or skull. We report a case of a male patient with sarcoidosis with multiple enlarged lymph nodes, skin and bone lesions, and the scintigraphic findings.