[Soft palate transnasal retractor]. / Retractor transnasal del paladar blando.

INTRODUCTION: An anterior transoral approach allows the surgeon to access the lower portion of the clivus; to the first, second or third thoracic vertebra. It is indispensible that the teeth, lips, cheeks and tongue be retracted to avoid interposition on the surgical field. This retraction is carried out by means of a Dingman separator. Nevertheless, generally the soft palate is elevated with sutures through the nasal fossa. Because this invasive method could damage soft tissues, we have designed a basket to separate the soft palate from the surgical field, thus allowing the surgeon to maneuver with comfort and without damaging structures. TECHNIQUE: A 30-cm segment of 22 gauge wire is passed through each end of a thin sheet of silicon (4 x 3 x 1.5 cm) forming a basket. With the patient under general anesthesia, both free ends of the wire are introduced into the buccal cavity in the same manner nasal packing is used to control epistaxis. Each end of the wire is slid from the mouth through the nasal fossa to bring them outside the face. Traction is placed on both ends of the wire allowing the intraoral band of silicon to elevate and hold the soft palate. CLINICAL CASE: We present the case of a 64-year-old woman with spastic quadriparesis and hyperreflexia predominantly of the upper extremities, in addition to trophic changes due to arthritis of long duration. Imaging studies demonstrated nonreducible subluxation of the atlantoaxial joint with ventral compression of the bulbomedullar union by the odontoid apophysis. Resection of the anterior arch of the atlas and apophyses was made via the transoral route, where retraction of the soft palate by means of the described basket was employed. The patient did not experience significant sequelae as a result of the technique utilized.

Prevalencia de cáncer del aparato digestivo en población derechohabiente del IMSS en el Estado de Sinaloa, México / Prevalence of digestive tract cancer in IMSS patients in Sinaloa, Mexico

Objetivo: Determinar la frecuencias de neoplasias malignas del aparato digestivo en derechohabientes atendidos en hospital de concentración del IMSS en Culiacán, Sinaloa, México. Método: De 32,067 reportes histopatológicos realizados en el Departamanto de Patología del Hospital General Regional No. 1 del IMSS en Culiacán, Sínaloa, se identificaron 406 estudios reportados con neoplasia maligna del tubo digestivo (NMTD); edad y sexo de los pacientes fueron analizados así como sitio de afección y estirpe histológica. Neoplasias benignas y metastásicas fueron excluidas. Resultados: Prevalencia NMTD: 1.26 por ciento; edad más afectada: 60-69 años; predilección por sujetos masculinos (66 por ciento), p < 0.0001. Globalmente, 47.2 por ciento de los estudios reportaron cáncer gástrico, 17.5 por ciento colon y recto, 8.4 por ciento vesícula y vías biliares, 8.1 por ciento cáncer hepático, el resto localizado en otros niveles. Tasas de NMTD por estirpe histológica similares a las de otros hospitales de concentración del país. Conclusiones: NMTD en población derechohabiente del IMSS en Sinaloa con magnitud relevante al considerar las registradas en otros centros hospitalarios. Posiblemente existen factores regionales que contribuyen a este comportamiento