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1.
Cytokine ; 138: 155400, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33338918

RESUMO

Influenza B virus (IBV) causes respiratory infectious disease. Cytokines are important immune mediators during infectious diseases. Cortisol and stress have been related to respiratory infection susceptibility and cytokine regulation. Little is known about systemic cytokines, cortisol, and perceived stress in the early stages of IBV infection. We researched the systemic cytokines and cortisol, as well as the perceived stress and blood cell count in patients infected with IBV. The diagnosis was established using the Luminex xTAG RVP kit and confirmed with qRT-PCR for IBV viral load. The perceived stress was evaluated using the perceived stress scale (PSS-10). Twenty-five plasma cytokines were determined using multiplex immunoassay and cortisol by ELISA. The leukocyte differential count was measured with a standard laboratory protocol. Th1, Th17, and IL-10 cytokines were higher in IBV infected patients (P < 0.05). Leukocytes and neutrophil count negatively correlated with viral load (P < 0.05). Perceived stress had a negative effect on monocyte and systemic cytokines in IBV infected patients (P < 0.05). Cortisol was higher in patients infected with IBV and correlated positively with CCL20 (P < 0.05). Cortisol showed a positive effect on most of the systemic cytokines (P < 0.05). In conclusion, a cytokine pattern was found in IBV infected patients, as well as the possible role of leukocyte counts in the control of IBV. Our results suggest the importance of cortisol and perceived stress on systemic cytokines in patients infected with IBV, but more studies are needed to understand their role in cytokine production in respiratory infectious disease.


Assuntos
Citocinas/sangue , Hidrocortisona/sangue , Influenza Humana/sangue , Percepção , Estresse Psicológico , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Vírus da Influenza B/metabolismo , Leucócitos/citologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Carga Viral
2.
Surg Radiol Anat ; 43(4): 537-544, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33386458

RESUMO

OBJECTIVES: To explore a method to create affordable anatomical models of the biliary tree that are adequate for training laparoscopic cholecystectomy with an in-house built simulator. METHODS: We used a fused deposition modeling 3D printer to create molds of Acrylonitrile Butadiene Styrene (ABS) from Digital Imaging and Communication on Medicine (DICOM) images, and the molds were filled with silicone rubber. Thirteen surgeons with 4-5-year experience in the procedure evaluated the molds using a low-cost in-house built simulator utilizing a 5-point Likert-type scale. RESULTS: Molds produced through this method had a consistent anatomical appearance and overall realism that evaluators agreed or definitely agreed (4.5/5). Evaluators agreed on recommending the mold for resident surgical training. CONCLUSIONS: 3D-printed molds created through this method can be applied to create affordable high-quality educational anatomical models of the biliary tree for training laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica/educação , Ducto Cístico/anatomia & histologia , Internato e Residência/métodos , Modelos Anatômicos , Treinamento por Simulação/métodos , Colangiopancreatografia por Ressonância Magnética , Ducto Cístico/diagnóstico por imagem , Ducto Cístico/cirurgia , Humanos , Internato e Residência/economia , Impressão Tridimensional , Treinamento por Simulação/economia , Cirurgiões/educação
3.
Mol Med ; 23: 101-111, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28474731

RESUMO

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer tumors. Comparisons between TNBC and non-triple negative breast cancer (nTNBC) may help to differentiate key components involved in TNBC neoplasms. The purpose of the study was to analyze the expression profile of TNBC versus nTNBC tumors in a homogeneous population from northeastern Mexico. A prospective study of 50 patients was conducted (25 TNBC and 25 nTNBC). Clinic parameters were equally distributed for TNBC and nTNBC: age at diagnosis (51 vs 47 years, p=0.1), glucose levels (107 mg/dl vs 104 mg/dl, p=0.64), and body mass index (28 vs 29, p=0.14), respectively. Core biopsies were collected for histopathological diagnosis and gene expression analyses. Total RNA was isolated and expression profiling was performed. 40 genes showed differential expression pattern in TNBC tumors. Among these, 9 over-expressed genes (PRKX/PRKY, UGT8, HMGA1, LPIN1, HAPLN3, and ANKRD11), and one under-expressed (ANX9) gene are involved in general metabolism. Based on this biochemical peculiarity, and the over-expression of BCL11A and FOXC1 (involved in tumor growth and metastasis, respectively) we validated by qPCR the expression profile of 7 genes out of the signature. In this report, a new gene signature for TNBC is proposed. To our knowledge, this is the first TNBC signature which describes genes involved in general metabolism. The findings may be pertinent for Mexican patients and require to be evaluated in further ethnic groups and populations.


Assuntos
Regulação Neoplásica da Expressão Gênica , Neoplasias de Mama Triplo Negativas/genética , Adulto , Idoso , Feminino , Perfilação da Expressão Gênica , Humanos , México , Pessoa de Meia-Idade , Terapia Neoadjuvante
4.
Biotechnol Lett ; 37(4): 779-85, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25515795

RESUMO

Fusokines are proteins formed by the fusion of two cytokines. They have greater bioavailability and therapeutic potential than individual cytokines or a combination of different cytokines. Interferon-gamma-inducible protein 10 (CXCL10) and lymphotactin (XCL1) are members of the chemotactic family of cytokines, which induce tumor regression by eliciting immune-system cell chemotaxis. We engineered a replication-deficient adenoviral system expressing CXCL10/XCL1 fusokine (Ad FIL) and assessed its chemotactic response in vitro and in vivo. The CXCL10/XCL1 fusokine elicited a greater chemotactic effect in IL-2 stimulated lymphocytes than individual or combined cytokines in vitro. CXCL10/XCL1 fusokine biological activity was demonstrated in vivo by intratumoral chemoattraction of CXCR3+ cells. Thus, this novel CXCL10/XCL1 fusokine may represent a potential tool for gene therapy treatment of cancer and other illnesses that require triggering immune-system cell recruitment.


Assuntos
Quimiocina CXCL10/metabolismo , Quimiocinas C/metabolismo , Quimiotaxia , Vetores Genéticos , Linfócitos/fisiologia , Mastadenovirus/genética , Animais , Linhagem Celular , Quimiocina CXCL10/genética , Quimiocinas C/genética , Humanos , Linfócitos/efeitos dos fármacos , Camundongos Endogâmicos C57BL
5.
Biotechnol Lett ; 36(12): 2489-94, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25214209

RESUMO

Interleukin-22 (IL-22) participates in the modulation of innate immunity and inflammation. This cytokine has important therapeutic potential, such as with ulcerative colitis, liver and lung injury, and infection, in different animal models. We generated a Lactococcus lactis strain that secretes human IL-22 under the regulation of the nisin-inducible promoter. Identification and secretion of this cytokine was demonstrated using western blots of culture supernatants from IL-22-expressing bacteria. The recombinant IL-22 protein produced by L. lactis was biologically active as determined by its ability to induce IL-10 secretion when co-cultured with a colon epithelial cell line in vitro. We consider this novel strain a promising live vaccine for various therapeutic applications.


Assuntos
Interleucinas/metabolismo , Lactococcus lactis/metabolismo , Western Blotting , Linhagem Celular , Meios de Cultura/química , Células Epiteliais/efeitos dos fármacos , Expressão Gênica , Regulação Bacteriana da Expressão Gênica/efeitos dos fármacos , Humanos , Interleucinas/genética , Lactococcus lactis/genética , Nisina/metabolismo , Regiões Promotoras Genéticas , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Interleucina 22
6.
Cir Cir ; 92(1): 124-127, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38537227

RESUMO

Wernicke encephalopathy, which is caused by a thiamine deficiency, occurs in 0.8-2% of the population. Only 16% present the typical triad of this disease: nystagmus, confusion and ataxia. We present the case of a postoperative patient with a one anastomosis gastric bypass with reoperation undergoing a Roux-en-Y gastric bypass that begins with confusion and nystagmus on her third postoperative day. The diagnosis of Wernicke encephalopathy is made by imaging, and vitamin B1 is administered with total improvement of nystagmus and altered state of consciousness (lethargy, bradypsychia, bradylalia).


La encefalopatía de Wernicke se produce por una deficiencia de tiamina se presenta en un 0.8-2% de la población. Solo el 16% de los casos presentan la tríada típica de esta enfermedad: nistagmo, confusión y ataxia. Presentamos el caso de una paciente operada de bypass gástrico de una anastomosis con reintervención convirtiendo a bypass gástrico en Y de Roux que en su tercer día de posoperatorio comienza con confusión y nistagmo. Se realiza por imagen el diagnóstico de encefalopatía de Wernicke se administra vitamina B1 con mejoría total del nistagmo y alteración del estado de consciencia (letargia, bradipsiquia, bradilalia).


Assuntos
Derivação Gástrica , Encefalopatia de Wernicke , Humanos , Feminino , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Tiamina/uso terapêutico
7.
Cir Cir ; 91(6): 835-838, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38096879

RESUMO

24-year-old man with positive HIV, with a giant exofitic anal condyloma, with a clinical presentation of a painfull suppurative anal condyloma with a pathology report of an in situ squamous cell carcinoma. The purpose of the investigation is a case report and the procedure was observational. The finding was a Buschke-Lowenstein tumor.


Varón de 24 años, con infección por el virus de la inmunodeficiencia humana, que presenta una tumoración exofítica, dolorosa y supurativa, con reporte positivo de virus de papiloma humano y reporte histopatológico de carcinoma espinocelular sin evidencia de diseminación (in situ). El propósito de la investigación es un reporte de caso y el procedimientos fue observacional. El hallazgo fue un tumor de Buschke-Lowenstein.


Assuntos
Tumor de Buschke-Lowenstein , Carcinoma de Células Escamosas , Condiloma Acuminado , Masculino , Humanos , Tumor de Buschke-Lowenstein/cirurgia , Tumor de Buschke-Lowenstein/patologia , Condiloma Acuminado/complicações , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/cirurgia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Canal Anal
8.
Cureus ; 15(11): e49459, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38152798

RESUMO

Mesenteric cysts (MCs), rare entities of embryologic origin, predominantly affect the small bowel's mesentery. The clinical manifestations of MCs often lack specificity, which complicates diagnosis. Given their rarity, detailed reporting of MC cases is essential to enhance understanding and improve treatment strategies. We present a case of a 45-year-old male who presented to the emergency department with a one-month history of abdominal pain in the umbilical region, postprandial fullness, progressive decrease in food intake, 12 kg weight loss, and increased abdominal girth. Computed tomography (CT) imaging revealed a well-defined mass in the jejunoileal area. During the exploratory laparotomy, we identified and excised a fibrotic mass on the mesentery of the ileal jejunum, which was not adherent to the intestines. We discharged the patient with no complications following an uneventful four-day observational period. Histopathological examination, including immunohistochemical staining, confirmed the lesion as a non-pancreatic mesenteric pseudocyst. On the follow-up visit, the patient reported no complications. This case report underscores the solitary, multilocular nature of the jejunoileal MC, distinct for its serosanguineous fluid content. In conclusion, this case highlights the diagnostic challenge of MCs and illustrates the potential for successful management with a timely and multidisciplinary approach.

9.
J Surg Case Rep ; 2023(7): rjad407, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37489161

RESUMO

The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some genetic component has been found in the etiology. A newborn full-term male, weighing at 1910 g at birth, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. Duodenal membrane is suspected after persistent postprandial vomiting and abdominal distension; his abdomen was distended, hyperresonant and soft. The gastroduodenal series showed data compatible with a duodenal membrane so exploratory laparotomy was performed, finding the pancreas completely wrapping the second portion of the duodenum, so a diamond-shaped-duodenoduodenostomy anastomosis was performed. The AP should be considered, especially in male neonates with postprandial vomiting, abdominal distension, who show some other congenital anomaly, and in the abdominal X-ray, the sign of the double bubble is observed.

10.
Cureus ; 15(9): e45732, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37868387

RESUMO

Acute appendicitis is the most common cause of abdominal pain that requires surgery. Appendiceal cancer is rare, comprising nearly 4% of all gastrointestinal diagnoses. It is common to find neuroendocrine neoplasms due to metastasis in this site. Appendix tumors are usually asymptomatic; however, if they are advanced or have metastases, they can cause abdominal symptoms. Computed tomography (CT) is commonly used to diagnose acute appendicitis in these cases. CT usually shows an increased appendiceal diameter with thickening (>3 mm) of the appendiceal wall, an intraluminal fluid depth >2.6 mm, and periappendiceal inflammation. Histopathological findings confirm the diagnosis. Medical and surgical management depends on physical characteristics such as size, location, and degree of evolution. We present the case of a 77-year-old woman with a family history of well-controlled type 2 diabetes mellitus and hypertension. She was referred to our institution after four days of abdominal pain in the epigastrium and both flanks accompanied by fever. An abdominal CT showed left pleural effusion and appendicular thickening. Laboratory tests showed high blood glucose levels, leukocytosis at the expense of neutrophils, an increased platelet count, and decreased albumin and total proteins. The CT scan also showed a calcified granuloma in the anterior segment of the right upper lobe and an irregular image with partially defined hypodense borders in the liver in segment IVb. We report our experience with the diagnosis, management, and treatment decisions of this case. It is important to mention that the first diagnosis was acute appendicitis. This diagnosis motivated us to seek other symptoms and signs by direct questioning and imaging studies leading us to diagnose metastatic lung cancer.

11.
J Surg Case Rep ; 2022(7): rjac336, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35892124

RESUMO

The purpose of this report is to present the case of a patient with situs inversus totalis (SIT) who underwent laparoscopic gastric bypass and review of the literature. Situs inversus is a rare congenital abnormality that occurs in ~0.01% of the population and is characterized by transposition of the abdominal viscera1. When associated with dextrocardia, it is known as SIT. Electrocardiography reveals a reversal of the electrical waves of the heart and is the diagnostic measure of choice. Roux-en-Y laparoscopic gastric bypass for morbid obesity is one of the most effective bariatric procedures currently considered as the gold standard in bariatric surgery. We present the case of a 19-year-old male with morbid obesity and diagnosis of SIT, who underwent a laparoscopic gastric bypass adjusting the technique to the anatomical changes typical of this variant. It can be concluded, based on the previously compared cases and what was reported in ours, that in patients who have an indication to perform bariatric surgery and present SIT, surgery is not contraindicated, obtaining favorable results.

12.
J Surg Case Rep ; 2022(2): rjac016, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35198140

RESUMO

Neimeier, in 1934, proposed a classification for gallbladder perforation. The first type is fistulation between the gallbladder and adjacent viscerae. The second type is a subacute perforation surrounded by an abscess walled off by adhesions from the general peritoneal cavity; and the third type is a peritonitis due to free biliary spillage into the peritoneal cavity without protective adhesions. We will analyze a Neimeier's type 1 perforation. The patient is a 72-year-old male diagnosed with a cholecystolithiasis and empyema due to a cholecystopleural fistula. Was operated by laparoscopic surgery because its low rate of complications, and lower days at hospital staying. Everything went as planned with no complications. Even though it is not a common presentation, it sets a precedent for it to be furthermore researched, and for it to be used as a literary option in a discussion to know which type of surgery is better for these cases.

13.
Cir Esp (Engl Ed) ; 100(10): 629-634, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36109114

RESUMO

BACKGROUND: Penetrating neck injuries represent 5-10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. METHODS: This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. RESULTS: A total of 70 neck exploration cases were reviewed, 34 (49%) didn't had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. CONCLUSIONS: Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided.


Assuntos
Lesões do Pescoço , Ferimentos Penetrantes , Humanos , Pescoço , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/cirurgia , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia
15.
Cir Cir ; 89(1): 39-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33498070

RESUMO

BACKGROUND: Traumatic injuries represent 9.6% of the global surface of the disease and represent the third most common cause of death in adults and adolescents. Patients were admitted to the hospital presenting traumatic injuries, penetrating abdominal traumatism remains a major cause of morbidity and mortality. OBJECTIVE: To analyze the presentation, handling and development of patient's gunshot wound. METHOD: Retrospective, descriptive, observational study. It was reviewed from 2010-2015 in the statistics department of the University Hospital Dr. José E. González all patients diagnosed with firearm projectile injury in abdomen. RESULTS: Were admitted above an average of 1.22 ± 0.51 lesions, on a Glasgow coma scale of 13.59 ± 2.5, oxygen saturation of 96.2 ± 2.09, heart rate of 94.4 ± 20, respiratory rate of 22 ± 6 and shock degree of 1.5 ± 0.80. CONCLUSION: Vital signs and specific characteristics of the lesion are essential and useful for the prediction of mortality due to abdominal traumatism by firearm projectile, in addition to the quantification of wounds and associated organic lesions, these are being evaluated both as a whole and separately.


ANTECEDENTES: Las lesiones traumáticas representan el 9.6% de la carga global de la enfermedad y son la tercera causa más común de muerte en adultos y adolescentes. Entre los pacientes ingresados en el hospital con lesiones traumáticas, el traumatismo penetrante abdominal sigue siendo una importante causa de morbilidad y mortalidad. OBJETIVO: Analizar la presentación, el manejo y la evolución de los pacientes con herida por proyectil de arma de fuego en el abdomen. MÉTODO: Estudio retrospectivo, descriptivo y observacional. Se revisaron todos los pacientes con diagnóstico de herida por proyectil de arma de fuego en el abdomen en el departamento de estadística del Hospital Universitario Dr. José E. González durante los años 2010-2015. RESULTADOS: Del total, 21 (9.1%) pacientes eran del sexo femenino y 229 (90.9%) del sexo masculino. Se ingresaron con un promedio de 1.22 ± 0.51 lesiones, con una puntuación en la Escala de coma de Glasgow de 13.59 ± 2.5, saturación de oxígeno de 96.2 ± 2.09, frecuencia cardiaca de 94.4 ± 20, frecuencia respiratoria de 22 ± 6 y grado de choque de 1.5 ± 0.80. CONCLUSIÓN: Los signos vitales y las características específicas de la lesión son esenciales y útiles para la predicción de la mortalidad por traumatismo abdominal por proyectil de arma de fuego, además de la cuantificación de heridas y lesiones orgánicas asociadas, siendo evaluadas estas tanto en un todo como por separado.


Assuntos
Traumatismos Abdominais , Ferimentos por Arma de Fogo , Abdome , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Humanos , México/epidemiologia , Nigéria , Estudos Retrospectivos , Violência , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/cirurgia
16.
Cir Cir ; 89(1): 89-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33498074

RESUMO

BACKGROUND: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. OBJECTIVE: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. METHOD: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. RESULTS: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. CONCLUSIONS: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.


ANTECEDENTES: La fístula biliopleural es una comunicación poco frecuente entre el sistema biliar y el espacio pleural secundario a ruptura de quistes hidatídicos, cirugías hepatobiliares o heridas penetrantes Existe poco sobre el tema en la literatura por lo que no existe un protocolo estandarizado para su manejo. OBJETIVO: El objetivo de este trabajo es determinar ventajas y desventajas del uso de CPRE como tratamiento inicial conservador para fístulas biliopleurales. MÉTODO: Nuestro estudio retrospectivo incluyó pacientes con diagnóstico de fístula biliopleural quienes fueron sometidos a CPRE como tratamiento inicial, mayores de 18 años en un período de Agosto de 2016 a Agosto de 2019. RESULTADOS: Se incluyeron 8 pacientes con diagnístico de fístula biliopleural, 75% hombres y 25% mujeres con una media de edad de 24.5 años; la etiología traumática fue a predominante en nuestro grupo (89%), el diagnóstico se realizó entre los días 3 y 14 post colocación de sonda torácica y obtuvimos éxito en el tratamiento de la fístula con CPRE en el 87.5% de nuestros pacientes. CONCLUSIONES: El uso de CPRE como tratamiento inicial para fístula biliopleural debe ser considerada como la herramienta inicial en el algoritmo de manejo de esta entidad.


Assuntos
Fístula Biliar , Colangiopancreatografia Retrógrada Endoscópica , Adulto , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Tubos Torácicos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Esfinterotomia Endoscópica , Adulto Jovem
17.
Cir Cir ; 89(S1): 82-86, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762638

RESUMO

The traumatic diaphragmatic hernia is considered a rare clinic condition and represents a diagnostic challenge. Its presentation is mainly a surgical emergency, leading to scarce time for complementary image studies. We present a case of a 21-year-old male who suffered a penetrating wound in the left hemitorax from whom is suspected to have a traumatic visceral herniation into the thoracic cavity by chest X-ray, confirming a splenic herniation with intrathoracic hemorrhage, as well as the proposal of a management algorithm for this defiant cases.


La hernia diafragmática traumática es poco frecuente en la clínica y representa un reto diagnóstico, ya que su aparición es principalmente de emergencia y esto propicia poco tiempo para la realización de estudios de imagen complementarios. Presentamos el caso de un varón de 21 años que sufrió una herida penetrante en el hemitórax izquierdo con sospecha de herniación traumática diafragmática de vísceras abdominales al tórax por radiografía, y en el quirófano se confirmó una herniación esplénica con hemorragia intratorácica. Se propone un algoritmo de manejo en estos casos tan desafiantes.


Assuntos
Hérnia Diafragmática Traumática , Ferimentos Penetrantes , Adulto , Diafragma/diagnóstico por imagem , Diafragma/lesões , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Hérnia Diafragmática Traumática/complicações , Hérnia Diafragmática Traumática/diagnóstico por imagem , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Ruptura , Adulto Jovem
18.
Cir Cir ; 89(3): 354-360, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34037613

RESUMO

INTRODUCCIÓN: Un trauma penetrante puede dañar una variedad de órganos. Dado que el hígado es un órgano sólido inelástico, no tiene la tolerancia al estiramiento necesaria para hacer frente a una herida por proyectil de arma de fuego (GSW). MÉTODOS: Este fue un estudio retrospectivo, observacional y descriptivo de 53 registros clínicos de pacientes ingresados en el Departamento de Cirugía por trauma hepático (LT) por un GSW. RESULTADOS: Del total de historias clínicas analizadas, el 89% de los pacientes presentaron una lesión asociada con LT. La lesión orgánica asociada más frecuente fue la torácica, específicamente la lesión pulmonar, en el 58%. El predictor más importante de mortalidad fue una estancia en la unidad de cuidados intensivos (UCI), que aumentó el riesgo unas 21 veces. CONCLUSIÓN: Una estadía en la UCI, seguida de la presencia de fracturas, fue el predictor más importante de mortalidad. Se necesitan nuevas medidas de pronóstico para contrarrestar las variables que ha creado el aumento de GSW, además de disminuir el tiempo de espera desde el evento traumático hasta el tratamiento relevante. INTRODUCTION: A penetrating trauma can damage a variety of organs. Since the liver is an inelastic solid organ, it does not have the necessary stretch tolerance to cope with a gunshot wound (GSW). METHODS: This was a retrospective, observational, and descriptive study of 53 clinical records of patients admitted to the Department of Surgery for liver trauma (LT) by a GSW. RESULTS: Of the total clinical records analyzed, 89% of the patients presented a lesion associated with LT. The most common associated organic lesion was thoracic, specifically lung injury, in 58%. The most important predictor of mortality was a stay in the intensive care unit (ICU), which increased the risk about 21 times. CONCLUSION: A stay in the ICU, followed by the presence of fractures, was the most important predictor of mortality. New prognostic measures are needed to counteract the variables that the increase in GSWs has created, in addition to decreasing the waiting time from the traumatic event to relevant treatment.


Assuntos
Ferimentos por Arma de Fogo , Humanos , Unidades de Terapia Intensiva , Fígado/cirurgia , Estudos Retrospectivos , Ferimentos por Arma de Fogo/cirurgia
19.
Cir Cir ; 89(S1): 1-5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762621

RESUMO

INTRODUCTION: Spontaneous splenic rupture from tuberculosis (TB) is a very unusual presentation within the wide range of presentations of this infectious disease. CLINICAL CASE: A 40-year-old male with a diagnosis of human immunodeficiency virus, begins with fever and pain in the left hypochondrium. A computed tomography scan was performed, showing probable splenic abscesses; suddenly, it begins with hemodynamic deterioration, exacerbation of pain, a surgical exploration was performed, showing spontaneous splenic rupture. Microscopic study of the spleen shows the presence of Mycobacterium tuberculosis. CONCLUSIONS: This is yet another presentation of TB, which can become a surgical emergency.


INTRODUCCIÓN: La ruptura esplénica espontánea por tuberculosis es una presentación muy inusual dentro de la amplia gama de presentaciones de esta enfermedad infectocontagiosa. CASO CLÍNICO: Masculino de 40 años con diagnóstico de VIH, inicia con fiebre y dolor en hipocondrio izquierdo. Se realiza TAC evidenciando probables abscesos esplénicos; súbitamente comienza con deterioro hemodinámico, agudización del dolor, se realiza exploración quirúrgica evidenciando ruptura esplénica espontánea. Al estudio microscópico del bazo se observa presencia de Mycobacterium Tuberculosis. CONCLUSIONES: Esta es una presentación más de la TB, la cual puede convertirse en una urgencia quirúrgica.


Assuntos
Esplenopatias , Ruptura Esplênica , Tuberculose , Adulto , Humanos , Masculino , Ruptura Espontânea , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Tuberculose/complicações , Tuberculose/diagnóstico
20.
Cir Cir ; 88(Suppl 2): 35-37, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33284280

RESUMO

Las duplicaciones gastrointestinales son malformaciones congénitas raras que pueden presentarse en diferentes partes del tracto gastrointestinal, de tamaño y sintomatología variable. Las duplicaciones gástricas representan el 3-5% de estas malformaciones. La presentación más frecuente es la quística, en la mayoría de los casos en la curvatura mayor. El diagnóstico es raro en la edad adulta y el tratamiento de elección es quirúrgico, el cual puede llevarse a cabo de forma convencional o por mínima invasión. Se presenta el caso de una mujer adulta con diagnóstico de quiste de duplicación gástrica en fondo gástrico adyacente a la unión gastroesofágica a quien se realizó resección total por laparoscopia.Gastrointestinal duplications are rare congenital malformations, they can appear in different parts of the gastrointestinal tract, of variable size and symptomatology. Gastric duplications represent 3-5% of these malformations, the most frequent presentation is statistical, located mostly in the greater curvature, the diagnosis is rare in adulthood, the treatment of choice is surgical, which can be carried out in a conventional or minimally invasive manner. We present the case of an adult woman diagnosed with a gastric duplication cyst in the gastric fundus adjacent to the gastroesophageal junction, who underwent total resection by laparoscopy.


Assuntos
Laparoscopia , Adulto , Feminino , Humanos
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