¿Plastrón o tumor apendicular? / Plastron appendicitis or appendiceal tumor?

Un plastrón apendicular es una masa apendicular palpable que contiene el apéndice inflamado, vísceras adyacentes y el omento mayor, asociado a o no a la presencia de pus. El manejo del plastrón apendicular abscedado es controvertido. Cuando hay signos de sepsis asociados, la indicación es una intervención quirúrgica de urgencia, de lo contrario puede optarse por un tratamiento conservador. La utilización de drenaje percutáneo tiene una alta tasa de efectividad, aunque la tasa de neoplasias no detectadas presenta un porcentaje no despreciable, especialmente en los pacientes mayores de 40 años. El objetivo de esta presentación es comunicar una paciente de 65 años con diagnóstico presuntivo de plastrón apendicular abscedado quien luego del fracaso de los drenajes percutáneos fue sometida a una laparotomía exploratoria y hemicolectomía derecha. El diagnóstico histopatológico fue de adenocarcinoma mucinoso del apéndice. (AU)

A palpable inflammatory appendiceal mass may contain the inflamed appendix, adjacent viscera, and the greater omentum, associated or not with the presence of pus. The management of an inflammatory appendiceal mass is controversial. When there are associated signs of sepsis, the indication is emergency surgery, otherwise, you can opt for a conservative treatment. The use of percutaneous drainage has a high rate of effectiveness, although the rate of undetected neoplasia is not negligible, especially in patients older than 40 years. We present the case of a 65-year-old female patient with a presumptive diagnosis of an appendiceal mass with abscess, who underwent exploratory laparotomy and right hemicolectomy after percutaneous drainage failure. The histopathological diagnosis was mucinous adenocarcinoma of the appendix. (AU)

Consideraciones actuales concernientes al tratamiento del plastrón apendicular / Current Considerations Concerning Treatment of Appendiceal Plastron

Introducción: El plastrón apendicular es una tumoración inflamatoria constituida por el apéndice inflamado, vísceras adyacentes y epiplón mayor. Puede contener o no pus (absceso/flemón). Objetivo: Precisar si está indicada la apendicectomía de urgencia o de intervalo en los pacientes con plastrón y/o absceso apendicular sometidos a tratamiento no quirúrgico inicial. Métodos: Se realizó una revisión en las bases de datos bibliográficas Web of Science, PubMed, Medline y Lilacs, mediante el motor de búsqueda Google académico. Se seleccionaron 28 artículos en inglés y español; 20 (71,2 por ciento) correspondieron al quinquenio 2016-20 y el 96,4 por ciento de autores extranjeros. Desarrollo: El estándar actual es el tratamiento no quirúrgico inicial del plastrón y el drenaje percutáneo del absceso. La apendicectomía de intervalo tiene un beneficio mínimo y puede conducir a un aumento de los costos, estancia hospitalaria, antibioticoterapia intravenosa y de la morbilidad. Se debe realizar un seguimiento cuidadoso en enfermos con riesgo de enfermedad inflamatoria intestinal o cáncer de colon, sin importar qué opción se elija (operación de intervalo u observación). Conclusiones: La apendicectomía de urgencia no es recomendable porque el componente inflamatorio la hace técnicamente difícil, puede necesitar una colectomía y aumentar la morbilidad, aunque actualmente, la apendicectomía laparoscópica de urgencia puede ser más rentable y segura. La decisión posterior de la apendicectomía a intervalos sigue siendo discutible. El intervalo recomendado varía entre 6 y 8 semanas, tres y seis meses después de la normalización clínico humoral(AU)

Introduction: Appendiceal plastron is an inflammatory tumor made up of inflamed appendix, adjacent viscera and greater omentum. It may or may not contain pus (abscess/phlegmon). Objective: To specify whether emergency or interval appendectomy is indicated in patients with appendicular abscess and/or plastron who had undergone initial nonsurgical treatment. Methods: A review was carried out in the bibliographic databases Web of Science, PubMed, Medline and Lilacs, using the search engine Google Scholar. Twenty-eight articles were selected, in English and Spanish; twenty (71.2 percent) corresponded to the quinquennium 2016-20, while 96.4 percent were written by foreign authors. Development: The current standard is the initial nonsurgical treatment of the plastron and percutaneous drainage of the abscess. Interval appendectomy has minimal benefits and can lead to increased costs, hospital stay, intravenous antibiotic therapy and morbidity. Patients at risk for inflammatory bowel disease or colon cancer should be carefully followed up, regardless of which option is chosen (interval operation or observation). Conclusions: Emergency appendectomy is not recommended because the inflammatory component makes it technically difficult; it may require colectomy and increase morbidity, although currently, emergency laparoscopic appendectomy may be more profitable and safer. The subsequent decision for interval appendectomy remains debatable. The recommended interval varies from six to eight weeks, three and six months after clinical-humoral normalization(AU)

Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal. Reporte de un caso / Internal Hernia Strangulated by Plastron in the Distal Third of the Cecal Appendix. Case Report

Resumen Las hernias internas son causa infrecuente de obstrucción intestinal con una incidencia del 0.2-0.9%, por lo que su diagnóstico temprano representa un reto. El órgano más frecuentemente herniado es el intestino delgado, lo que confiere un gran espectro de síntomas, desde dolor abdominal ligero hasta datos de abdomen agudo1,2. Se presenta el caso de una paciente de 8 años de edad con sintomatología digestiva inespecífica; se realizó diagnóstico transoperatorio en el que se encontró hernia interna estrangulada por plastrón en el tercio distal del apéndice. Se realizó apendicectomía y a los cuatro días se dio de alta sin complicaciones.

Abstract Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen1,2. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

Celiotomy by plastrotomy in a yellow-footed tortoise (geochelone denticulata)

One herein reports a successful case of celiotomy by plastrotomy for removal of foreign bodies in yellow-footed tortoise (Geochelone denticulata). The animal was treated at the Veterinary Hospital of the Federal University of Piaui, with appetite loss, regurgitation, constipation, lethargy, reluctance to walk and slightly reddish ocular mucous membranes. Radiographic examination was performed, confirming the presence of foreign bodies in the stomach. The tortoise underwent celiotomy by plastrotomy for the removal of the foreign bodies. The opening of the plastron was performed through the abdominal shields, with the aid of a circular mini grinding saw. One performed an incision in the midline between the two abdominal veins to access the abdominal cavity. A gastrotomy for removal of the foreign bodies (nails, toothpicks, stones, pieces of plastic, glass and crockery pieces) was performed after the location of the stomach. The surgery was successful and confirmed with radiographic evaluation in the immediate postoperative period. The celiotomy by plastrotomy for removal of foreign bodies in that animal proved to be a viable, very important and safe technique to the survival of chelonians.

Neste relato descreve-se um caso bem sucedido de celiotomia por plastrotomia para remoção de corpos estranhos em uma jabuti-tinga (Geochelone denticulata). O animal foi atendido no Hospital Veterinário da Universidade Federal do Piauí apresentando falta de apetite, regurgitação, constipação, letargia, relutância em andar e mucosas oculares hiperêmicas. Foi realizado exame radiográfico, o qual confirmou presença de corpos estranhos no estômago. O animal foi submetido à celiotomia por plastrotomia para remoção dos corpos estranhos. A abertura do plastrão foi realizada através dos escudos abdominais, com o auxílio de uma mini-serra circular de retífica. Foi feita uma incisão na linha média entre as duas veias abdominais para se acessar a cavidade abdominal e, uma vez exposto, o estômago foi incisado para remoção dos corpos estranhos (grampos, palitos de dente, pedras, peças de plástico, fragmentos de louças e vidros). A cirurgia foi bem sucedida e a remoção total dos corpos estranhos foi confirmada por radiografia realizada no pós-operatório imediato. A celiotomia por plastrotomia para remoção de corpos estranhos neste animal demonstrou ser uma técnica muito importante, segura e viável para a sobrevivência de quelônios.

The research progress of traditional Chinese medicine inducing bone mesenchymal stem cells / 国际中医中药杂志

Through referring to relevant works and the latest literature, the application and research progress of the traditional Chinese medicine inducing mesenchymal stem cells were summarized. The researching results focusing on induction and proliferation of mesenchymal stem cell by salvia, notoginseng, tortoise plastron, pilose antler, ginseng, astragalus were introduced.

Diverticulitis perforada en seis mujeres posmenopáusicas / Perforated diverticulitis six postmenopausal women

Objetivo: Comunicar la perforación diverticular del colon ocurrida en 6 mujeres menopáusicas en una consulta privada de ginecología durante el período de 1980 a 2005 en la Policlínica Maracaibo, Maracaibo. Venezuela. Casos clínicos. Seis mujeres posmenopáusicas con antecedentes de cirugía previa abdominal que acudieron por dolor pélvico, secreción vaginal y signos inflamatorios a quienes se les realizó el diagnóstico de enfermedad diverticular del colon perforada. No hubo obstrucción o hemorragias, pero sí la formación de abscesos y fistulas. Resultados: De las 6 pacientes, 5 que recibieron tratamiento médico, quirúrgico o combinados, evolucionaron satisfactoriamente. En una se desconoce el curso de la enfermedad. Conclusión: La enfermedad diverticular del colon, sintomática o asintomática (diverticulosis) y sus formas de complicaciones (diverticulitis, hemorragia, absceso, perforación, plastrón) son frecuentes en la mujer que envejece y no parece existir relación con el déficit estrogénico que acompaña a la menopáusica, del momento de su aparición o del uso de terapia de reemplazo hormonal; sin embargo, en esta serie todas tenían antecedentes de cirugía previa y adherencias que pudieran haber facilitado la perforación intestinal. El diagnóstico a menudo es clínico, radiológico o endoscópico. El tratamiento inicial es medicamentoso pero a menudo puede llegar a ser quirúrgico, realizándose colectomía parcial en su mayoría.

Objective: To report the diverticular perforation of the colon in 6 menopausal women in a private gynecology clinic for a period of 1980 to 2005 in the Policlinica Maracaibo, Maracaibo. Venezuela. Clinical cases. Six postmenopausal women with a history of prior abdominal surgery who have had pelvic pain, vaginal discharge and signs of abdomino-pelvic inflammation who underwent diagnosis of perforated diverticular disease of the colon. There was no obstruction or bleeding, but the formation of abscesses and fistulas . Results: Of the 6 patients, 5 were receiving medical, surgical or combined treatment evolved satisfactorily. In a patient the course of the disease is unknown. Conclusion: Diverticular disease of the colon in asintomatic or sintomatic forms (diverticulosis) and it´s complications (diverticulitis, bleeding, abscess, perforation and plastron) are common in aging women and no relationships with estrogen deficiency accompanying menopause, the time of onset or the use of hormone replacement therapy, but in this series all had previous surgery and adhesions that may have facilitated the intestinal perforation. The diagnosis is often clinical, radiological and endoscopic. The initial treatment is medical, but often should be surgical: partial colectomy performed mostly.

Functionality of the plastron in adults of Neochetina eichhorniae Warner (Coleoptera, Curculionidae): aspects of the integument coating and submersion laboratory experiments / Funcionalidade do plastrão em adultos de Neochetina eichhorniae Warner (Coleoptera, Curculionidae): aspectos do revestimento tegumentar e experimentos laboratoriais de submersão

The plastron theory was tested in adults of Neochetina eichhorniae Warner, 1970, through the analysis of the structure that coats these insects' integument and also through submersion laboratorial experiments. The tegument processes were recognized in three types: agglutinated scales with large perforations, plumose scales of varied sizes and shapes, and hairs. The experiments were carried out on 264 adult individuals which were kept submerged at different time intervals (n = 11) and in two types of treatment, natural non-aerated water and previously boiled water, with four repetitions for each treatment. The tests showed a maximum mortality after 24 hours of immersion in the previously boiled water treatment. The survival of the adults was negative and significantly correlated with the types of treatment employed and within the different time intervals. The values of oxygen dissolved in water (mg/l) differed significantly within the types of treatment employed. They were positively correlated with the survival of the adults in the two types of treatment, although more markedly in the treatment with previously boiled water. The mortality of adults after 24 hours of submersion in the treatment with previously boiled water may be associated with the physical-chemical conditions of the non-tested water in this study, such as low surface tension and concentration of solutes. These results suggest plastron functionality in the adults of this species.

A teoria plastrão foi testada em adultos de Neochetina eichhorniae Warner, 1970, por meio da análise da estrutura que reveste o tegumento destes insetos e em experimentos laboratoriais de submersão. Os processos tegumentares foram reconhecidos em três tipos: escamas aglutinadas e com perfurações largas; escamas plumosas de tamanhos e formas variadas; e pêlos. Os experimentos realizados com 264 indivíduos adultos os quais permaneciam submersos por diferentes intervalos de tempo (n = 11) e em dois tratamentos, água natural não aerada e água previamente fervida, com quatro repetições para cada tratamento, revelaram uma mortalidade máxima após 24 horas de mergulho no tratamento água previamente fervida. A sobrevivência dos adultos foi negativa e significativamente correlacionada com os tratamentos empregados e entre os diferentes intervalos de tempo. Os valores de oxigênio dissolvido (mg/l) na água diferiram significativamente entre os tratamentos aplicados, sendo positivamente correlacionado com a sobrevivência dos adultos nos dois tratamentos, embora mais acentuadamente no tratamento com água previamente fervida. A mortalidade dos adultos após 24 horas de mergulho no tratamento com água previamente fervida pode estar associada às condições físico-químicas da água não testadas neste estudo, como, por exemplo, baixa tensão superficial e concentração de solutos. Estes resultados sugerem uma funcionalidade do plastrão nos adultos desta espécie.

Tratamiento quirúrgico de apendicitis aguda en embarazo de 34 semanas / Surgical treatment of acute appendicitis in a 34-week pregnancy

El presente articulo trata de una paciente de 18 años de edad, quien cursa un embarazo de 34 semanas, Veinte horas de ingresar a la sala de emergencia presentó dolor abdominal difuso de gran intensidad que posteriormente se localizó en el lado derecho del abdomen. El dolor se acompaño de nausea y vómito y era progresivamente más intenso. Los exámenes de laboratorio demostraron leucocitos con derivación a la izquierda y un examen elemental y microscópico de orina con características infecciosas. La ecografía no demostró signos concluyentes de patología intraabdominal. se realizó una laparoscopía en la que se encontró un plastrón apendicular formado por ileon terminal y trompa derecha y se realizó una apendectomía. Evolucionó satisfactoriamente en el postoperatorio siendo dada de alta dos días después de la cirugía. la paciente posteriormente ingreso al hospital al cumplir 39 semanas de embarazo presentando actividad uterina siendo sometida a cesárea obteniéndose un recién nacido vivo de sexo masculino en buen estado general.

This article deals with an 18-year-old patient, who is in a 34-week pregnancy. Twenty hours after entering the emergency room, she presented diffuse abdominal pain of great intensity that was later located on the right side of the abdomen. The pain was accompanied by nausea and vomiting and was progressively more intense. Laboratory examinations showed leukocytes with a left shunt and an elemental and microscopic examination of urine with infectious characteristics. Ultrasonography did not show conclusive signs of intra-abdominal pathology. a laparoscopy was performed in which an appendicular plastron formed by the terminal ileum and right tube was found and an appendectomy was performed. She evolved satisfactorily in the postoperative period, being discharged two days after surgery. the patient subsequently entered the hospital at the 39th week of pregnancy presenting uterine activity undergoing caesarean section obtaining a live male newborn in good general condition.