Intestinal obstruction due to bariolith impaction.

"Bariolith" is defined as the concretion of barium sulfate in the intestine after performing a radiological study with said contrast. Complications derived from the use of barium are exceptional, but appendicitis, intussusception, volvulus, ulceration, ischemia and perforation have been described. We present the case of a 62 years old woman, who underwent a EGD exploration on the 15th of January 2021 as a part of her study for suspected GERD.

Sistema de ventilación mecánica y satisfacción de los pacientes del Hospital II de Tarapoto - EsSalud, 2018 / Mechanical ventilation system and patient satisfaction at Tarapoto Hospital II - EsSalud, 2018

El presente informe titulado "Sistema de ventilación mecánica y la satisfacción de los pacientes del Hospital II de Tarapoto ­ EsSalud, 2018"; tuvo como objetivo general, determinar la relación entre el sistema de ventilación mecánica y la satisfacción de los pacientes del nosocomio en estudio. El diseño de investigación fue descriptivo correlacional, la muestra lo conformaron 60 pacientes mayores de edad; la recolección de datos se hizo a través del cuestionario, la información recabada se procesó a través del Microsoft Excel; la presentación de los resultados se hizo a través de tablas y gráficos. En la correlación de las variables se utilizó el estadígrafo chi cuadrado. Los resultados obtenidos en lo correlacional, el sistema de ventilación y la satisfacción de los pacientes del Hospital II de Tarapoto ­ EsSalud, 2018; Como el Chi Cuadrado de Pearson (43,628), es notablemente mayor que el Chi tabular con 16 grados de libertad (26,296) y se sitúa en el rango de probabilidad de rechazo, por lo tanto, se rechaza la hipótesis nula con un 95% de confianza. Se concluye que, las variables son dependientes y de esta manera hay relación significativa entre ellas. Por ello, que se debe tener en cuenta que, a mejor ventilación, la satisfacción del paciente será mayor y viceversa. Lo que demuestra que la ventilación mecánica repercute en la insatisfacción de los pacientes.

Fibrin patch influences the expression of hypoxia-inducible factor-1α and nuclear factor-κBp65 factors on ischemic intestinal anastomosis.

The intestinal anastomotic failure is one of the most severe complications in gastrointestinal surgery. Despite the great surgical improvements during the last decade, anastomotic leak rates remain practically the same, with a dramatically high grade of morbidity for patients. Leakages are usually the final consequence of ischemia in the anastomosis, leading to tissue hypoxia. In response to hypoxia, the cell orchestrates a variety of coordinated responses in order to restore oxygen homeostasis. The molecular mechanism of hypoxia sensitivity involves oxygen sensing hydroxylases, prolyl-hydroxylases, orchestrating two main transcription factors related to induction of inflammation and angiogenesis, namely nuclear factor-κB and hypoxia-inducible factors. The immunohistochemical expression of two transcription factors hypoxia-inducible factors-1α and nuclear factor-κB p65 has already been described in several disorders, including wound healing, asthma and chronic obstructive lung disease, rheumatoid arthritis, cancer, inflammatory bowel disease, and acute colitis. In the surgical field, fibrin sealants have been widely used to prevent leaks in lung surgery and they might also be useful as a reinforcement of sutures in intestinal anastomosis. The commercial fibrin sealant patches are hemostatic and adhesive surgical agents mainly derived from human plasma. We herein report the results of a prospective randomized experimental study on pigs. We performed a high-risk leakage model of bowel anastomosis, causing a significant devascularization of 10-15 cm of the bowel wall before performing a conventional colo-ileal anastomosis. We randomized the animals to receive a covering of the anastomosis with a fibrin patch (case group) or not (control group). We report the changes in the immunohistochemical expression of the proteins involved in tissue response to hypoxia in the experimental model. Our results indicate that the fibrin patch delays the healing response, promoting a longer lasting inflammation in the surgical bed. Nevertheless, the fibrin patches effectiveness to reduce dehiscence shown in clinical practice suggests that this delay does not negatively affect patients' outcome. Impact statement The consequences of the anastomotic failure are dramatic for patients. Understanding how the ever-increasing use of fibrin sealant, that seems to have a beneficial effect on the anastomoses, interacts with the tissue and the healing process can help to justify its use and encourage research on how to improve this effect even more. We feel that the present work shows that the patch can improve healing by complex mechanisms other than the mere contention and physical support of the intestine. Furthermore, research is needed to confirm our preliminary findings.

Retroperitoneal paraganglioma-Is pre operative embolization useful?

INTRODUCTION: Paragangliomas (PG) are rare tumors derived from chromaffin cells that are located outside the adrenal gland and are capable of producing catecholamines. The treatment is based on a surgical resection, and there is controversy regarding the usefulness of previously carrying out an embolization and what is the most adequate surgical approach. CLINICAL CASE: We will present a 17-year-old woman with a retroperitoneal tumour in contact with the aorta and the inferior vena cava, treated with embolization prior to the surgical resection via laparotomy. DISCUSSION: The PG tumors are very infrequent and originate in the extra-adrenal chromaffin cells that exist in the vicinity of the components of the autonomic nervous system. Most of them (86%) produce catecholamines, are unique, sporadic, benign and more frequent in middle-aged women. Since they are radioresistant tumors, the only possibility for a cure is by a complete surgical excision. The preoperative embolization has been described mainly as the treatment of cervical PG, although its use in abdominal PG is more controversial and is not done in a systematic manner. CONCLUSION: We can conclude that the embolization of abdominal PG is not free of risks and that it has not been demonstrated that it significantly reduces the peri-operative bleeding or the surgical time. Probably, the embolization should be reserved for intensively hypervascularized and larger PGs.

Laparoscopic treatment of retroperitoneal cystic mesothelioma. Two cases reported.

Retroperitoneal cystic mesothelioma is a very rare lesion. The pathogeny is unclear and establishing a preoperative diagnosis versus others retroperitoneal cystic lesions is difficult. Thus, with increasing experience in laparoscopic retroperitoneal surgery, the use of this approach for exploration of a retroperitoneal mass of unknown origin may provide an alternative to classic open surgery and all the benefits of laparoscopy. We present two cases treated laparoscopycally and review the literature.

Manejo conservador de un absceso esplénico por émbolos sépticos tras extracciones dentarias / Conservative management of splenic abscess septic emboli after tooth extractions

Los abscesos esplénicos son poco frecuentes pero pueden asociar una mortalidad elevada. Generalmente suceden en pacientes con una infección sistémica relacionada con algún estado de compromiso inmunitario. La clínica es inespecífica y el diagnóstico suele ser tardío, aunque el desarrollo de técnicas de imagen más avanzadas ha permitido un mejor diagnóstico de los abscesos esplénicos y isponer del drenaje percutáneo como una opción terapéutica complementaria válida y segura. Presentamos un caso de un paciente con un absceso esplénico por émbolos sépticos tras extracciones dentarias, manejado conservadoramente con antibioticoterapia y drenaje percutáneo (AU)

Splenic abscesses are rare but may be associated with high mortality. Usually they occur in patients with systemic infection related to some immunocompromised state. The symptoms are nonspecific and the diagnosis is often late, but the development of better imaging techniques has enabled better diagnosis of splenic abscess and percutaneous drainage is a valid and safe complementary treatment option. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions, managed conservatively with antibiotics and percutaneous drainage (AU)

Conservative management of splenic abscess septic emboli after tooth extractions.

Splenic abscesses are rare but may be associated with high mortality. Usually they occur in patients with systemic infection related to some immunocompromised state. The symptoms are nonspecific and the diagnosis is often late, but the development of better imaging techniques has enabled better diagnosis of splenic abscess and percutaneous drainage is a valid and safe complementary treatment option. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions, managed conservatively with antibiotics and percutaneous drainage.

Neurofibroma esporádico sobre unión esofagogástrica. A propósito de un caso / Sporadic neurofibroma on the esophagogastric junction. A case report

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Estómago de retención gigante por atracones bulímicos / Gigantic gastric retention due to bulimic binge eating

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Bacterial adherence to different meshes used in abdominal surgery.

BACKGROUND: We studied the influence of morphology and type of material of abdominal wall prostheses in the avoidance of bacterial adhesion in acute and chronic mesh infections. METHODS: Three different types of prostheses were compared: 1) High-density polypropylene monofilament mesh (PMM); 2) low-density PMM; and 3) prostheses composed of low-density polypropylene and a non-porous hydrophilic film (composite prostheses). Microbial adhesion tests were performed using reference strains of Staphylococcus aureus 15981, Staphylococcus epidermidis ATCC 35984, Mycobacterium abscessus DSM 44196, and Mycobacterium fortuitum ATCC 13756 using a protocol described previously. RESULTS: Both Staphylococcus spp. and M. fortuitum strains showed lower adherence to PMM. Mycobacterium abscessus also exhibited lower adherence to composite prostheses. Both Mycobacterium spp. strains had lower adherence than Staphylococcus spp. strains for all materials except for low-density PMM. Mycobacterium fortuitum showed higher adherence to composite prostheses than M. abscessus, whereas the latter species had higher adherence to high-density PMM than M. fortuitum. CONCLUSION: Depending on the type of bacteria, collagen-coated hydrophilic prostheses with a large surface increased bacterial adherence significantly. These differences should be taken into consideration when choosing a mesh graft, which limits infection in abdominal wall reconstruction.

A simplified incision of the external oblique aponeurosis during the components separation technique for the repair of large incisional hernias.

Incising the external oblique muscle aponeurosis is an important part of the components separation technique for the repair of large incisional hernias. Endoscopically assisted section has been suggested to prevent complications of extensive skin flap formation. We used a simplified method for incising the external oblique aponeurosis, using a modified Collin Hartmann retractor, in 14 patients for the repair of large incisional hernias. Eight women and 6 men, with a mean (± standard deviation) age of 61.9 ± 14.9 years, underwent surgery. The median transverse diameter of the defect was 8.6 ± 3.0 cm. No postoperative morbidity occurred except 1 case of skin necrosis. One patient had a recurrence. Sectioning the external oblique aponeurosis during the components separation method using the technique described is a simple, safe, and economic approach that can prevent the complications described after the original techniques.