Common bile duct pressure after open intraoperative instrumentation in patients with uncomplicated choledocholithiasis.

BACKGROUND: Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations. MATERIAL AND METHODS: A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples. RESULTS: Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm H2O) registered were as follows: Initial = 19.5, week 1 = 16.2, week 2 = 14.3, week 3 = 13.0, week 4 = 12.1, week 5 = 11.1, and week 6 = 9.7. There were significant differences shown when comparing week 2 (p = 0.05), week 3 (p = 0.036), week 4 (p = 0.023), week 5 (p = 0.010), and week 6 (p = 0.004) with the initial value. CONCLUSIONS: CBDP decreases between 2nd and 3rd post-operative weeks. The use of choledochomanometry is useful in clinical scenarios with no access to imaging or interventionism facilities as in remote populations or rural locations.

ANTECEDENTES: La presión del conducto biliar común (PCBC) después de exploración quirúrgica no ha sido totalmente detallada. El objetivo fue describir los cambios de la PCBC tras exploración por coledocolitiasis. MATERIAL Y MÉTODOS: Estudio de antes y después, en pacientes con coledocolitiasis, que requirieron colecistectomía con exploración de vías biliares, registrando la PCBC por 6 semanas. Con colangiografía por sonda en T en la semana seis. Análisis con T de Student para muestras pareadas. RESULTADOS: Se incluyeron 13 pacientes (rango 17-69 años; 38,69 ± 17,97). Las presiones medias del CBC fueron: Inicial = 19.5, semana 1 = 16.2, semana 2 = 14.3, semana 3 = 13.0, semana 4 = 12.1, semana 5 = 11.1 y semana 6 = 9.7. Se mostraron diferencias significativas al comparar la semana 2 (p = 0.05), la semana 3 (p = 0.036), la semana 4 (p = 0.023), la semana 5 (p = 0.010) y la semana 6 (p = 0.004) contra el valor inicial. DISCUSIÓN: La PCBC disminuye entre la segunda y la tercera semana posoperatoria. La coledocomanometría muestra ser útil en escenarios clínicos sin acceso a intervencionismo como en poblaciones remotas o localidades rurales.

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure.

Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.

[Sutureless thyroidectomy with local anesthesia plus conscious sedation. Two clinical cases]. / Tiroidectomía sin suturas con anestesia local más sedación consciente. Dos casos clínicos.

OBJECTIVE: We proposed a modification of thyroid surgery and have reported two operations carried out with sutureless surgery and local anesthesia. Our study setting was Unit 305 of the General Hospital of Mexico in Mexico City. With regard to study design, two patients are presented with sutureless thyroid surgery in what we believe is the first publication of its kind in Mexico and probably the first publication in the world that reports the combination of both sutureless technique and local anesthesia. MATERIAL AND METHODS: Patient number 1 is 41 years of age with a 10-year history. Fine-needle biopsy denoted nodular goiter but definitive diagnosis was Hashimoto thyroiditis, for which we performed subtotal resection. Patient number 2 is 46 years of age, and has a history of 1 year of thyroid mass; final diagnosis was colloid goiter. Lobectomy and isthmus resection was done. We proceeded under local anesthesia plus sedation with the patient conscious, in combination with no stitches for hemostasia using a tissue-sealing system ligasure. RESULTS: Both patients had good results without postoperative complications. Surgical time was 120 min in first case and 71 min for the second. Patient 1 had transient hoarseness for 3 weeks, and the healing was spontaneous. CONCLUSION: Outcome was adequate in these two cases with local anesthesia and no stitches.

[Familial adenomatous polyposis: case report of male twins]. / Poliposis adenomatosa familiar: presentación de dos casos en gemelos masculinos idénticos.

BACKGROUND: One hundred percent of the cases of familial adenomatous polyposis (FAP) will develop carcinoma; therefore, the necessity of diagnosis at an early age with immediate therapy is essential. In the presence of identical twins, it is mandatory for both to undergo comprehensive colonic examination as early as possible. The study took place at a third-level general hospital with the objective of explaining in detail the importance of early diagnosis of FAP. CLINICAL CASES: We report on FAP in identical male twins who were operated on at different times with different outcomes and prognosis. The first twin was treated 20 years previously at an early age and underwent subtotal colectomy with ileoproctostomy. This patient is currently asymptomatic with no evidence of malignancy. The second twin was operated on at the age of 33 years and was already a carrier of a well differentiated rectal adenocarcinoma. CONCLUSIONS: Opportune therapy carried out on the first twin has resulted in a disease-free status, in contrast with the delay in treatment of the second twin who developed carcinoma.

Inguinodinia en postoperados de plastía inguinal con técnica de Lichtenstein con resección versus preservación del nervio ilioinguinal ipsilateral / Inguinodynia in patients after inguinal hernioplasty with the Lichtenstein technique with resection versus preservation of the ipsilateral ilioinguinal nerve

Objetivo: Evaluar la inguinodinia en pacientes postoperados de plastía inguinal tipo Lichtenstein, comparando la sección contra la preservación de nervio ilioinguinal. Sede: Clínica de Hernias del Servicio de Cirugía General del Hospital General de México. Diseño: Ensayo clínico controlado, doble ciego. Análisis estadístico: Prueba de Wilcoxon y U de Mann-Whitney. Material y métodos: A 40 pacientes se les realizó plastía tipo Lichtenstein; aleatoriamente, en 18 se seccionó el nervio ilioinguinal y en 22 se preservó. Se evaluó la sensibilidad cutánea pre y postoperatoria, con escala visual análoga para la intensidad del dolor, con el fin de determinar si la sección del nervio ilioinguinal disminuye o no la intensidad del dolor y la presentación de inguinodinia postoperatoria. Resultados: Hubo diferencia significativa en cuanto a reducción del dolor a favor de los pacientes en que se seccionó el nervio a partir de 24 horas del postoperatorio (p < 0.001) y a los 60 días del postoperatorio (p < 0.0001), sin presentarse inguinodinia, alodinia, ni molestias por la hipoestesia o anestesia. Conclusión: La sección del nervio ilioinguinal durante la reparación de la hernia inguinal con la técnica de Lichtenstein disminuye el dolor postoperatorio en forma óptima, sin alterar en forma importante la sensibilidad superficial y además evita la inguinodinia.

Poliposis adenomatosa familiar: presentación de dos casos en gemelos masculinos idénticos / Familial adenomatous polyposis: case report of male twins

BACKGROUND: One hundred percent of the cases of familial adenomatous polyposis (FAP) will develop carcinoma; therefore, the necessity of diagnosis at an early age with immediate therapy is essential. In the presence of identical twins, it is mandatory for both to undergo comprehensive colonic examination as early as possible. The study took place at a third-level general hospital with the objective of explaining in detail the importance of early diagnosis of FAP. CLINICAL CASES: We report on FAP in identical male twins who were operated on at different times with different outcomes and prognosis. The first twin was treated 20 years previously at an early age and underwent subtotal colectomy with ileoproctostomy. This patient is currently asymptomatic with no evidence of malignancy. The second twin was operated on at the age of 33 years and was already a carrier of a well differentiated rectal adenocarcinoma. CONCLUSIONS: Opportune therapy carried out on the first twin has resulted in a disease-free status, in contrast with the delay in treatment of the second twin who developed carcinoma.