ABSTRACT
Introducción. La colelitiasis tiene una prevalencia del 15 % y el 21 % tendrá coledocolitiasis al momento de la colecistectomía, con 50 % de probabilidad de presentar complicaciones asociadas. Desde el advenimiento de la colecistectomía laparoscópica, el abordaje de la coledocolitiasis ha sido endoscópico, usualmente en un tiempo diferente al vesicular, sin embargo, los avances en laparoscopia han permitido explorar la vía biliar común por la misma vía, pudiendo realizar ambos procedimientos en el mismo tiempo de forma segura. Métodos. Se realizó una búsqueda de la literatura existente con relación al enfoque para el manejo de la colecisto-coledocolitasis en un paso comparado con dos pasos. Resultados. Existe evidencia que demuestra mayor efectividad del abordaje en dos pasos, con CPRE y posterior colecistectomía laparoscópica, sobre el abordaje en un paso, especialmente en la tasa de fuga biliar y de cálculos retenidos. El enfoque en un paso con exploración de vías biliares y colecistectomía laparoscópica en el mismo tiempo es seguro, con alta tasa de éxito, baja incidencia de complicaciones, menor estancia hospitalaria y costos. Conclusión. El abordaje laparoscópico en un solo paso es un procedimiento seguro y eficaz para el manejo de la colecisto-coledocolitiasis, con el beneficio de estancia hospitalaria menor, sin embargo, se requieren habilidades técnicas avanzadas en cirugía laparoscópica. En nuestro medio ya existe una infraestructura para el manejo híbrido con CPRE y colecistectomía laparoscópica, pudiéndose realizar ambos en el mismo tiempo, para reducir estancia y costos.
Introduction. Cholelithiasis has a prevalence of 15%, and 21% will have choledocholithiasis at the time of cholecystectomy, with a 50% probability of presenting associated complications. Since the advent of laparoscopic cholecystectomy, the approach to choledocholithiasis has been endoscopic, normative at a different time than the gallbladder; however, advances in laparoscopy have made it possible to explore the common bile duct by the same route, being able to perform both procedures in a single time safely. Methods. A search of the existing literature was performed regarding the one-step approach compared to the two-step approach for the management of cholelithiasis and choledocholithiasis. Results. There is evidence that demonstrates greater effectiveness of the two-step approach with ERCP and subsequent laparoscopic cholecystectomy over the one-step approach, especially in the rate of bile leak and the incidence of retained stones. The one-step approach with bile duct exploration and laparoscopic cholecystectomy at the same time is safe, with a high success rate, low incidence of complications, shorter hospital stay, and lower costs. Conclusion. The one-step laparoscopic approach is a safe and effective procedure for the management cholelithiasis and concomitant choledocholithiasis, with the benefit of a shorter hospital stay; however, advanced technical skills in laparoscopic surgery are required. In our environment there is already an infrastructure for hybrid management with ERCP and laparoscopic cholecystectomy, both of which can be performed at the same time to reduce hospital stay and costs.
Subject(s)
Humans , Bile Ducts , Cholelithiasis , Choledocholithiasis , Cholecystectomy , Cholangiopancreatography, Endoscopic Retrograde , LaparoscopyABSTRACT
La agenesia esternal es una rara malformación del desarrollo embrionario del esternón, que puede estar o no relacionado con otras anomalías congénitas. Se presenta el caso de un paciente de 4 años de edad con agenesia esternal total, que fue llevado a reconstrucción de la pared torácica anterior con material protésico absorbible y pericardio bovino, logrando la adecuada estabilidad de la pared torácica y la corrección de la función de la misma, con una evolución satisfactoria después de dos años de seguimiento
Sternal cleft is a rare malformation of the embryonic development of the sternum, which may or may not be related to other congenital anomalies. We present the case of a 4-year-old patient with total sternal cleft, who underwent reconstruction of the anterior chest wall with absorbable prosthetic material and bovine pericardium, achieving adequate stability and correction of the function of the chest wall, with a satisfactory evolution after two years of follow-up
Subject(s)
Humans , Sternum , Musculoskeletal Abnormalities , Congenital AbnormalitiesABSTRACT
La infección por Helicobacter pylori (H. pylori), es la infección bacteriana crónica más frecuente de la raza humana, afecta al 50 % de la población mundial y, por lo menos, al 80 % de la población colombiana. Esta bacteria es re-conocida desde hace más de 15 años como un carcinógeno tipo I. De acuerdo con las indicaciones del Consenso de "Maastricht V" esta infección debe ser buscada y tratada en los pacientes con úlcera péptica activa, linfoma MALT (por sus siglas en inglés, mucosa associated lymphoid tissue), cáncer gástrico temprano, púrpura que presenten síntomas dispépticos crónicos y usuarios crónicos de AINES. Debido al papel que tiene en la fisiopatología del cáncer gástrico, nace la iniciativa de realizar una búsqueda activa del H. pylori y erradicarlo en todas las personas, incluyendo aquellas asintomáticas en países con alta incidencia de esta neoplasia. Existen diversas publicaciones alrededor del mundo que así lo sugieren, mostrando resultados con impacto positivo en el curso y progresión de la enfermedad, sobre todo en las etapas más tempranas de la infección. Sin embargo, otros autores resaltan la creciente problemática de la resistencia bacteriana, y demuestran que el peso estadístico y los diferentes análisis de los estudios disponibles en la actualidad tienen poca validez para dar una recomendación extendida al paciente asintomático. Se cuestiona que tal vez, estamos utilizando las estrategias inadecuadas para manejar una situación de salud pública, ya que estamos enfocados en impactar a cada individuo con terapias antibióticas complejas, en vez de a la población en general con políticas de salud pública
Helicobacter pylori (H. pylori) infection is the most frequent chronic bacterial infection in humans, affecting 50% of the world population, and at least 80% of the Colombian population. This bacteria has been recognized for more than 15 years as a type I carcinogen. According to the indications of the "Maastricht V" consensus, this infection should be sought and treated in patients with: active peptic ulcer, MALT lymphoma (for its acronym Mucosa associated lymphoid tissue), early gastric cancer, purpura who present with chronic dyspeptic symptoms and chronic users of NSAIDs. Due to the role it plays in the pathophysiology of gastric cancer, the initiative was born to carry out an active search for H. pylori and eradicate it in all people, including those asymptomatic in countries with a high incidence of this neoplasia.There are various publications around the world that suggest the effectiveness of this treatment and the positive impact on the course and progression of the disease, especially in the earliest stages of the infection, since the more advanced stages have less encouraging results regarding progression to malignancy. However, other authors highlight the growing problem of bacterial resistance that we are currently facing and demonstrate that the sta-tistical weight and the different analyzes of the currently available studies have little validity to give an extended recommendation to the asymptomatic patient. It is suggested that perhaps inappropriate strategies to manage this public health situation are being used, since we are focused on impacting each individual with complex antibiotic therapies, instead of the general population with public health policies
Subject(s)
Humans , Helicobacter pylori , Stomach Neoplasms , Drug Resistance, Bacterial , Mucosa-Associated Lymphoid Tissue Lymphoma Translocation 1 ProteinABSTRACT
ABSTRACT This study aimed to investigate the effects of low-level laser therapy (LLLT) on muscle repair in rats with chronic alcohol intake. Thirty male Wistar rats were distributed into three groups: injured tibialis anterior (TA) muscle without treatment (IC); chronic ingestion of alcohol plus injured TA muscle (AI); and chronic ingestion of alcohol plus injured TA plus LLLT (AIL). Each group was divided into two different subgroups, and rats were sacrificed on days 3 and 7 post-injury. Morphological features in the injured areas were similar with or without alcohol intake (IC and AI); however, LLLT promoted a decrease in the number of inflammatory cells and destroyed zones, as well as improved tissue organization (AIL). In general, alcohol intake caused a decrease in myogenic regulatory factors (MyoD and myogenin) and vascular endothelial growth factor in the AI group. Moreover, LLLT promoted recovery of these factors to the same level as in animals without alcohol intake (IC and AIL). LLLT was able to increase the expression of myogenic and vascular growth factors and stimulate skeletal muscle regeneration in rats with chronic alcohol intake.
ABSTRACT
As técnicas anestésicas para os nervos alveolar inferior, bucal e lingual possuem algum insucesso na clínica diária, porque as diretrizes para o local de penetração da agulha podem não causar o acesso adequado do anestésico ao nervo, devido às variações anatômicas das estruturas de referência, e variações na posição do nervo e estruturas vizinhas. As variações nas técnicas e no uso de agulhas anestésicas longas ou curtas também tem importância para alcançar a anestesia. Neste trabalho, nos propusemos a analisar as variações anatômicas da posição do forame da mandíbula, o uso de agulhas longas ou curtas, as duas principais técnicas para a anestesia dos nervos alveolar inferior, bucal e lingual, com dados clínicos obtidos a partir de um questionário. Este estudo foi dividido em três partes: análise em osso seco da posição do forame da mandíbula, relação da posição do nervo alveolar inferior na altura do forame da mandíbula e o comprimento das agulhas odontológicas, e um questionário clínico padrão. A partir dos dados recolhidos, concluímos que o forame da mandíbula em adultos pode possuir uma posição acima da altura da penetração da agulha, o que dificulta o acesso do anestésico ao nervo alveolar inferior. Nas mandíbulas infantis isto não ocorre, porque o forame sempre está mais inferior ao local de penetração da agulha. Agulhas curtas são eficazes quase sempre. A técnica de bloqueio do nervo alveolar inferior é eficaz para a anestesia dos nervos alveolar inferior, bucal e lingual, sendo a técnica de escolha, em detrimento da Gow-Gates.
The anesthetic techniques for the nerves alveolar inferior, buccal and lingual possess some failure in the daily clinic, because the lines of direction for the place of penetration of the needle can not cause the adequate access of the anesthetic to the nerve, which had to the anatomical variations of the structures of reference, and neighboring variations in the position of the nerve and structures. The variations in the techniques and the use of long or short anesthetic needles also have importance to reach the anesthesia. In this work, in we considered them to analyze the anatomical variations of the position of the foramen of the jaw, the use of long or short needles, the two main techniques for the anesthesia of the nerves alveolar inferior, buccal and lingual, with gotten clinical data from a questionnaire. This study it was divided in three parts: analysis in dry bone of the position of the foramen of the jaw, relation of the position of the inferior alveolar nerve in the height of the foramen of the jaw and the length of the odontologic needles, and a clinical questionnaire standard. From the collected data, we conclude that the foramen of the jaw in adults can possess a position above of the height of the penetration of the needle, what it makes it difficult the access of the anesthetic to the inferior alveolar nerve. In the infantile jaws this does not occur, because the foramen always is more inferior to the place of penetration of the needle. Short needles are efficient almost always. The technique of blockade of the inferior alveolar nerve is efficient for the anesthesia of the nerves alveolar inferior, buccal and lingual, being the choice technique, in detriment of the Gow-Gates.
Subject(s)
Humans , Anesthesia/methods , Mandible/anatomy & histology , Mandibular Nerve/anatomy & histology , Mandibular Nerve , Anesthetics, LocalABSTRACT
Os nervos alveolar inferior, lingual e bucal em seu trajeto estão próximos à região cirúrgica dos dentes terceiros molares inferiores. A literatura apresenta trabalhos que relatam a prevalência de lesão nos nervos alveolar inferior e lingual neste tipo de procedimento, porém não relata sobre a lesão no nervo bucal. Não existe consenso quanto a percentagem de lesão nervosa, tendo incidência variável entre vários trabalhos. Assim, nos propusemos a estudar as relações anatômicas destes três nervos com o dente terceiro molar inferior e a coletar dados clínicos da incidência de lesão. A relação do nervo alveolar inferior com o terceiro molar inferior foi analisada através de radiografias periapicais. A relação dos nervos lingual e bucal com o dente foi analisada através de peças cadavéricas. Os dados clínicos foram levantados através de questionário distribuído a cirurgiões dentistas. Os resultados obtidos foram: com relação ao nervo alveolar inferior, 40% das radiografias mostraram proximidade entre o terceiro molar inferior e o canal mandibular; com relação ao nervo lingual, obtivemos uma distância média de 21 mm com relação ao rebordo alveolar dos terceiros molares inferiores; o nervo bucal apresentou uma distância média de 11 mm da porção distal do terceiro molar inferior, superiormente a linha oblíqua da mandíbula; com relação aos dados clínicos, os profissionais participantes da pesquisa relataram uma incidência de 6% na lesão do nervo alveolar inferior e 3,5% na lesão do nervo lingual, com 0% na lesão do nervo bucal, durante a extração de terceiros molares inferiores.
The inferior alveolar, lingual and buccal nerves in its passage are next to the surgical region of third molar inferiors. Literature presents works that tell the prevalence of injury in the nerves inferior alveolar and lingual in this type of procedure, however does not tell on the injury in the buccal nerve. Does not exist consensus in the percentage of nervous injury, having changeable incidence between some works. So we propose to study the anatomical relations of these three nerves with the tooth third molar inferior and to collect clinical data of the injury incidence. The relation of the inferior alveolar nerve with the third molar inferior was analyzed through periapicais x-rays. The relation of the nerves lingual and buccal with the tooth was analyzed through body parts. The clinical data had been raised through distributed questionnaire to dentists. The gotten results had been: with regard to the inferior alveolar nerve, 40% of the x-rays had shown to proximity between the third molar inferior and the mandibular canal; with regard to the lingual nerve, we got a average of 21 mm with regard to the alveolar rim of the third molar inferiors; the buccal nerve presented a distance measured of 11 mm of the distal portion of the third molar inferior, superior the oblique line of the jaw; with regard to the clinical data, the participant professionals of the research had told an incidence of 6% in the injury of inferior alveolar nerve and 3.5% in the injury of the lingual nerve, with 0% in the injury of the buccal nerve, during the extration of third molar inferiors.
Subject(s)
Mandibular Nerve , Molar, Third , Mandibular Nerve/injuries , Radiography, Dental , Tooth ExtractionABSTRACT
Se estudió los efectos del CO2 en la mucosa del paladar duro de ratas Wistar. Los especímenes fueron fijados en solución de Karnovsky modificado y analizados a través de microscopía electrónica de barrido. La mucosa palatina normal presenta células epiteliales queratinizadas y pliegues de profundidad variable. El área carbonizada reveló gran cantidad de estructuras granuladas y agujeros de diferentes diámetros. La capa epitelial se mostró totalmente carbonizada y condensada en formaciones irregulares. En las áreas fundidas se observaron cráteres resultantes de la solidificación del material fundido y además, formas irregulares en toda su extensión