Diagnostic value of ultrasonography in Poland′s syndrome / 中华超声影像学杂志

Objective:To investigate the diagnostic value of ultrasonography in Poland′s syndrome.Methods:From February 2016 to December 2020, the ultrasonographic images of 15 patients with Poland′s syndrome diagnosed by Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed, and the ultrasonographic features were summarized.Results:High-frequency ultrasound could clearly show the anatomical structures of each layer of the chest wall of the patients with Poland′s syndrome. The sonogram of Poland′s syndrome mainly showed the absence of all or part of the pectoralis major on the affected side, some of which were combined with the absence of pectoralis minor. The difference between the thickness of the affected chest wall and the healthy side was statistically significant ( P<0.01). Among the 15 cases of Poland′s syndrome, 11 cases had brachydactyly or syndactyly. Ultrasound showed that the bifurcation position of the common palmar digital artery of the middle finger was lower than that of the healthy side. Conclusions:The ultrasonography is an effective imaging method for diagnosis of Poland′s syndrome.

Colgajo dorsal ancho por abordaje único vertical en el síndrome de Poland: caso clínico / Retalho latíssimo do dorso por abordagem único vertical na síndrome de Poland: caso clínico / Latissimus dorsi vertical single-approach flap in Poland syndrome: clinical case

El síndrome de Poland constituye una malformacion que asocia diversos grados de anomalia toracica y a nivel del miembro superior, con una incidencia de 1 cada 30000 nacidos vivos. Esta patologia geenra ausencia de la glandula mamaria y del musculo pectroral mayor como malformacion mas frecuente. Lo cual produce una asimetria a nivel de torax con perdida de la armonia la cual lleva a una alteracion tanto fisica como psicologica a nivel de la paciente. Por esto es necesario resolver esta patologia con la menor morbilidad posible. El planteo de generar la menor morbilidad nos llevo a realizar una tecnica por abordaje unico sub axilar, a traves del cual se diseca el musculo dorsal ancho y se transpone de forma anterior, obteniendo una sola incision, la cual se mantiene oculta debajo del miembro superior adducido. Produciendo menor tiempo operatorio, menor tiempo de internacion, disminuyendo el número de incsiones y logrando una adecuada fijacion anterior del musculo dorsal ancho.

Poland's syndrome is a malformation associated with varying degrees of thoracic and upper limb abnormality, with an incidence of 1 in 30,000 live births. This pathology generates the absence of the mammary gland and the major pectoral muscle as the most frequent malformation. Which produces an asymmetry at the chest level with loss of harmony which leads to both physical and psychological alteration at the level of the patient. For this reason, it is necessary to resolve this pathology with the least possible morbidity. The proposal to generate the least morbidity led us to perform a single sub axillary approach technique, through which the latissimus dorsi muscle is dissected and transposed anteriorly, obtaining a single incision, which is kept hidden under the upper limb adduced. Producing less operative time, shorter hospitalization time, reducing the number of incisions and achieving an adequate anterior fixation of the latissimus dorsi muscle.

A síndrome de Poland é uma malformação associada a vários graus de anomalia torácica e de membros superiores, com uma incidência de 1 em 30.000 nascidos vivos. Essa patologia gera a ausência da glândula mamária e do músculo pectoral principal como a malformação mais frequente. O que produz uma assimetria ao nível do peito com perda de harmonia que conduz a alterações físicas e psicológicas ao nível do paciente. Por isso, é necessário resolver essa patologia com a menor morbidade possível. A proposta de gerar o mínimo de morbidade nos levou a realizar uma única técnica de abordagem subaxilar, por meio da qual o músculo grande dorsal é dissecado e transposto anteriormente, obtendo-se uma única incisão, que é mantida escondida sob o membro superior. aduzido. Produzindo menos tempo operatório, menor tempo de internação, reduzindo o número de incisões e conseguindo uma fixação anterior adequada do músculo grande dorsal.

Síndrome de Poland. Reporte de un caso / Poland syndrome. Report of a case / Síndrome da Polônia. Relato de um caso

RESUMEN Introducción: el síndrome de Poland es un trastorno congénito raro que se caracteriza por la ausencia o hipoplasia unilateral del musculo pectoral mayor asociado a malformaciones en la extremidad superior y tejido mamario ipsilateral. Las manifestaciones clínicas en los recién nacidos solamente se describen en la literatura, por lo tanto, muchos aspectos de su presentación en las guarderías son ignoradas. Presentación del caso: presentamos el caso de un recién nacido que manifiesta una respiración paradójica desde el momento del nacimiento. Este tipo de hallazgo clínico esta vagamente descrito en el Síndrome de Poland y menos aún en el periodo neonatal. Discusión: este síndrome puede verse relacionado con enfermedades, como parálisis de los pares VI y VII, lo que conlleva a un mayor número de asociaciones complejas.9 Se plantea asociado a dextrocardia, que según algunos autores es secundaria a la deformidad torácica producida por malformaciones costales y su efecto sobre la formación cardíaca en el periodo embrionario. No se han observado deficiencias mentales ni trasmisión genética de la enfermedad. Se ha descrito de forma excepcional, asociación familiar. Esto podía corresponder a una herencia autosómica dominante con penetración reducida. Conclusiones: en este paciente el síndrome de Poland se caracterizó por una hipoplasia del pectoral mayor izquierdo, asociado a malformaciones esqueléticas de la mano del mismo lado.

ABSTRACT Introduction: Poland syndrome is a rare congenital disorder characterized by the unilateral absence or hypoplasia of the pectoralis major muscle associated with malformations of the upper limb and ipsilateral breast tissue. Clinical manifestations in newborns are only described in the literature, therefore, many aspects of their presentation in nurseries are ignored. Presentation of the case: we present the case of a newborn who manifests paradoxical respiration from the moment of birth. This type of clinical finding is loosely described in Poland Syndrome and even less in the neonatal period. Discussion: this syndrome can be related to diseases, such as paralysis of pairs VI and VII, which leads to a greater number of complex associations.9 It arises in association with dextrocardia, which according to some authors is secondary to the thoracic deformity caused by malformations ribs and their effect on cardiac formation in the embryonic period. No mental deficiencies or genetic transmission of the disease have been observed. An exceptional family association has been described. This could correspond to an autosomal dominant inheritance with reduced penetration. Conclusions: in this patient, Poland syndrome was characterized by hypoplasia of the left pectoralis major, associated with skeletal malformations of the hand on the same side.

RESUMO Introdução: A síndrome da Polônia é um distúrbio congênito raro caracterizado pela ausência ou hipoplasia unilateral do músculo peitoral maior associado a malformações do membro superior e tecido mamário ipsilateral. As manifestações clínicas em recém-nascidos são descritas apenas na literatura, portanto, muitos aspectos de sua apresentação nos berçários são ignorados. Apresentação do caso: apresentamos o caso de um recém-nascido que manifesta respiração paradoxal desde o momento do nascimento. Esse tipo de achado clínico é descrito livremente na Síndrome da Polônia e menos ainda no período neonatal. Discussão: essa síndrome pode estar relacionada a doenças, como a paralisia dos pares VI e VII, que leva a um maior número de associações complexas.9 Ela surge associada à dextrocardia, que segundo alguns autores é secundária à deformidade torácica causada por malformações costelas e seu efeito na formação cardíaca no período embrionário. Não foram observadas deficiências mentais ou transmissão genética da doença. Uma associação familiar excepcional foi descrita. Isso pode corresponder a uma herança autossômica dominante com penetração reduzida. Conclusões: nesse paciente, a síndrome da Polônia foi caracterizada por hipoplasia do peitoral maior esquerdo, associada a malformações esqueléticas da mão do mesmo lado.

Negative stereotypes: an analysis of Social Cognition in different ethnic groups. Social cognition of stereotypes / Estereotipos negativos: un análisis de la cognición social en diferentes grupos étnicos. Cognición social de los estereotipos

Abstract Introduction: The processes related to social cognitions contribute as a traumatic and stressful event for some ethnic and minority groups, causing a series of psychic suffering in individuals. Social cognition considered stereotypes as characteristics of a group included in its mental representation. Objective: The study was conducted to analyze the negative stereotypes in two cultures with very different history and geopolitical context, especially how stereotypes are reflected in the cognitive component of prejudiced attitudes. Method: Four hundred fifty one (N=451) undergraduate students volunteered to take part in the study, the participants came from careers in the area of Social Sciences and Humanities in the non-probabilistic sample. After receiving the information, participants completed Negative Stereotype Index. A descriptive analysis and the T-test to know the differences between the perception and self-perception of the groups. Results: Show that negative stereotype traits in Poland and Brazil, found negative stereotypic traits attributed to an out-group resulted in more unfavorable evaluations than descriptions consisting of positive attributes. In both groups, and their antecedents were associated with negative out-group attitudes, however, is a more general and more important one. Conclusion: The findings found that expectations about the out-group and negative stereotypes occur in conjunction with other negative emotions, which intensify negative out-group attitudes. The assessment that the Poles made of the Germans was like that of the Brazilians of the Argentines or of a group of relatively higher status. That is, they considered the Germans as more arrogant, sincere and less modest. The different groups of people may dislike each other for similar reasons. Explanations are offered for the limitations of the study and proposal for future research.

Resumen Introducción: Los procesos relacionados con cogniciones sociales contribuyen como evento traumático y estresante para algunos grupos étnicos y minoritarios que causan una serie de sufrimiento psíquico en los individuos. La cognición social considera los estereotipos como características de un grupo incluido en su representación mental. Objetivo: El estudio analiza los estereotipos negativos en dos culturas con historia y contexto geopolítico diferentes, especialmente cómo se reflejan los estereotipos en el componente cognitivo de las actitudes prejuiciosas. Método: Cuatrocientos cincuenta y un estudiantes de pregrado se ofrecieron como voluntarios para participar en el estudio, los participantes procedían de carreras en el área de Ciencias Sociales y Humanidades en la muestra no probabilística. Después de recibir la información, los participantes completaron el Índice de Estereotipos Negativos. Se realizó análisis descriptivo y prueba T-test de Student para conocer diferencias entre percepción y autopercepción de los grupos. Resultados: Muestran que los rasgos estereotipados en Polonia y Brasil hallaron atributos al exogrupo que resultaron en evaluaciones más desfavorables que en atributos positivos. En ambos grupos, sus antecedentes se asociaron con actitudes negativas para el exogrupo; sin embargo, es una cuestión más general y más importante. Conclusión: Los hallazgos encontrados mostraron que las expectativas sobre el exogrupo y los estereotipos negativos ocurren en conjunción con otras emociones negativas, que intensifican las actitudes negativas exogrupales. La valoración que los polacos hacían de los alemanes era similar a la que hacían los brasileños de los argentinos o de un grupo de estatus relativamente superior. Es decir, consideraban a los alemanes como más arrogantes, sinceros y menos modestos. Los diferentes grupos pueden no gustarle el uno al otro por razones similares. Se ofrecen explicaciones para las limitaciones del estudio y para futura investigación.

A rare case of Poland: Mobeius syndrome in an infant

Mobius syndrome is a rare condition of unclear origin, characterized by a unilateral or bilateral congenital facial weakness with impairment of ocular abduction, which is frequently associated with limb anomalies. Poland Syndrome is a rare condition that is evident at birth (congenital). Associated features may be extremely variable from case to case. However, it is classically characterized by absence (aplasia) of chest wall muscles on one side of the body (unilateral) and abnormally short, webbed fingers (symbrachydactyly) of the hand on the same side (ipsilateral). In those with the condition, there is typically unilateral absence of the pectoralis minor and the sternal or breastbone portion of the pectoralis major. In females, there may be underdevelopment or absence (aplasia) of one breast and underlying (subcutaneous) tissues. In some cases, associated skeletal abnormalities may also be present, such as underdevelopment or absence of upper ribs; elevation of the shoulder blade (Sprengel deformity); and/or shortening of the arm, with underdevelopment of the forearm bones (i.e., ulna and radius). Other associated abnormalities may include dextrocardia, diaphragmatic hernia and renal anomalies etc. Poland Syndrome affects males more commonly than females and most frequently involves the right side of the body. The exact cause of the condition is unknown. The combination of Poland-Mobius syndrome is rare, with an estimated prevalence 1:500 000.

Insomnia and the level of stress among students in Krakow, Poland / Insônia e nível de estresse em estudantes de Cracóvia, Polônia

Abstract Introduction: Stress and insomnia are increasing problems in young people in highly developed countries. They influence both the physical and psychological aspects of life and seem to be related to each other. Various strategies to cope with stress exist and can be used to reduce its level. The main goal of our study was to find a relationship between insomnia, stress, stress-coping strategies and selected social and medical factors among students. Methods: A cross-sectional study was conducted in March 2017 among students of seven public Krakow universities, using the Perceived Stress Scale 10, an abbreviated version of the Coping Orientation to Problems Experienced inventory (mini-COPE inventory) and the Athens Insomnia Scale. In the statistical analysis, the chi-square, Student's t test and Spearman's rank correlation coefficient were used. Results: A total of 264 students aged 22.22±1.5 years were involved in the study. High stress levels occurred in 10% of the respondents. A statistically higher level of stress was revealed in people suffering from chronic diseases (p=0.006) and in cigarette smokers (p=0.004). The most common stress-coping strategies were active coping and planning. Insomnia was present in 19.7% of the students. Insomnia level was correlated with the intensity of perceived stress (p=0.00; r=0.44). Conclusions: According to our study, one tenth of Krakow students perceive a high level of stress, and one fifth of the respondents suffer from insomnia. There is a strong positive correlation between level of insomnia and level of stress. To ensure high quality of life, problems such as stress and insomnia should be taken into consideration by every general practitioner.

Resumo Introdução: Estresse e insônia são problemas cada vez mais presentes em pessoas jovens em países altamente desenvolvidos. Eles influenciam tanto os aspectos físicos quanto os psicológicos da vida e parecem estar relacionados entre si. Várias estratégias de enfrentamento (coping) do estresse existem e podem ser usadas para reduzir seu nível. O objetivo principal deste estudo foi investigar a relação entre insônia, estresse, estratégias de coping, e certos fatores sociais e médicos em estudantes. Métodos: Um estudo transversal foi conduzido em março de 2017 com estudantes de sete universidades públicas da Cracóvia, na Polônia, utilizando a Escala de Estresse Percebido 10, uma versão abreviada do Inventário para Medir Estratégias de Enfrentamento de Estresse (mini-COPE) e a Athens Insomnia Scale. Na análise estatística, foram utilizados os testes qui-quadrado, t de Student e o coeficiente de correlação de Spearman. Resultados: Um total de 264 estudantes com idade média de 22,22±1,5 anos foram incluídos no estudo. Altos níveis de estresse ocorreram em 10% dos respondentes. Um nível estatisticamente mais alto de estresse foi revelado em pessoas sofrendo de doenças crônicas (p=0,006) e em fumantes (p=0,004). As estratégias de coping mais comuns foram coping ativo e planejamento. A insônia esteve presente em 19,7% dos alunos. O nível de insônia se correlacionou com a intensidade do estresse percebido (p=0,00; r=0,44). Conclusões: De acordo com este estudo, um décimo dos estudantes de Cracóvia percebe um alto nível de estresse, e um quinto dos respondentes sofrem de insônia. Há uma forte correlação positiva entre nível de insônia e nível de estresse. Para garantir alta qualidade de vida, problemas como estresse e insônia devem ser levados em consideração pelo médico generalista.

Quality of life and effects of breast reconstruction in patients with breast deficiency: a cross-sectional study / 中华整形外科杂志

Objective@#To investigate the satisfaction and well-being of Chinese women with breast deficiency, and to analyze the relevant influencing factors.@*Methods@#A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency, visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018. The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life.@*Results@#A total of 139 effective questionnaires were collected, including 83 patients before BR surgery and 56 post. There was no difference in quality of life in different ages, marital status, education levels, working status, and causes of breast deficiency. Mean scores of satisfaction with breasts, psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000), but there was no statistical difference in physical well-being-chest score. The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007). With regard to analysis of specific items, compared with preoperative patients, patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P<0.05).@*Conclusions@#The breast deficiency resulting from Poland syndrome, breast cancer and other causes, can lead to a significant decrease in quality of life. Breast reconstruction can improve satisfaction with breast, psychosocial and sexual well-being in women with breast deficiency. The abdomen well-being of patients with abdominal flap reconstruction is decreased. Therefore, more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.

Deformidad de la caja torácica / Chest wall deformity

Resumen Las deformidades de la caja torácica se pueden dividir en dos tipos, las que son productos del desarrollo anormal del pecho en el crecimiento y las congénitas que son las secundarias a una malformación estructural del pecho evidente en el nacimiento. Las malformaciones del desarrollo son las más comunes, como por ejemplo pectus excavatum o pectun carinatum. Las menos comunes son las de tipo congénito: síndrome de Poland, displasia espondilotorácica, displasia espondilocostal, síndrome de Jeune y los defectos de la costilla o el esternón. Las deformidades del pecho de tipo congénita se caracterizan por afectar la relación entre la columna vertebral, la caja torácica y los pulmones. La mayoría de estos pacientes desarrollan un disturbio respiratorio progresivo de tipo restrictivo conocido como Síndrome de Insuficiencia Torácica. Este síndrome se define como la deficiencia de la caja torácica para mantener una respiración normal y sostener el crecimiento fisiológico del pulmón. En este artículo discutiremos varias condiciones que afectan el desarrollo y función de la caja torácica.

Chest wall deformities are divided as an abnormal development during the growth or those secondary to a congenital malformation. The developmental type is the most common: pectus excavatum or pectus carinatum. The less common are the congenital types of chest wall abnormalities: Poland's syndrome, Jeune's syndrome, espondylothoracic dysplasia, espondylocostal dysplasia and defects of the ribs or sternum. The congenital type usually affects the relationship between the spine, rib cage and the lungs. Therefore, many of these patients will develop a progressive respiratory disturbance of restrictive type known as Thoracic Insufficiency Syndrome. Thoracic insufficiency syndrome is defining as a deficiency of the rib cage to maintain a normal respiration and to sustain the physiological growth of the lungs. In this article will discuss several conditions that will affect the development and function of the chest wall.

Síndrome de Poland: descripción de un caso en la sala de partos / Poland syndrome: Description of a case in the delivery room

El Síndrome de Poland es un trastorno congénito raro que se caracteriza por la ausencia o hipoplasia unilateral del musculo pectoral mayor asociado a malformaciones en la extremidad superior y tejido mamario ipsilateral. Las manifestaciones clínicas en los recién nacidos solamente se describen en la literatura, por lo tanto muchos aspectos de su presentación en las guarderías son ignoradas. Presentamos el caso de un recién nacido que manifiesta una respiración paradójica desde el momento del nacimiento. Este tipo de hallazgo clínico esta vagamente descrito en el Síndrome de Poland y menos aún en el periodo neonatal.

Poland Syndrome is a rare congenital condition characterized by the absence unilateral pectoralis major muscle. it can be associated with other multiple malformations usually in the same affected side. The clinical manifestation in newborns are merely described in the literature, therefore many aspect in its presentation in the nursery are ignored. We present the case of a newborn manifesting paradoxical breathing since birth. This clinical finding is barely describe in poland's syndrome and even less during newborn period.

Serie de Casos: Síndrome de Poland Completo vs. Incompleto. Resolución Quirúrgica / Case Series: Poland Syndrome Complete vs Incomplete. Surgical Resolution

INTRODUCCIÓN: El síndrome de Poland es una enfermedad congénita polimalformativa extremadamente rara, su etiología es aún desconocida, afectando principalmente el desarrollo del músculo pectoral mayor; se acompañan frecuentemente de malformaciones de la mano, mama, complejo areola-pezón, pectoral menor ipsilateral y otras malformaciones asociadas. Su diagnóstico se basa en un correcto examen clínico junto con una tomografía axial computarizada con reconstrucción en 3D. El tratamiento quirúrgico final es individualizado y dependerá de la existencia de una o más malformaciones. CASOS CLÍNICOS: Se trató de cuatro pacientes con cuadro clínico compatible con síndrome de Poland, siendo común el subdesarrollo o ausencia del músculo pectoral mayor. EVOLUCIÓN: Se realizó a cada paciente una tomografía axial computarizada con reconstrucción en 3D para confirmar su diagnóstico y realizar un tratamiento quirúrgico según la necesidad de cada paciente, después del procedimiento se dio seguimiento a los pacientes con una respuesta favorable y sin complicaciones. CONCLUSIONES: El síndrome de Poland se caracteriza por un cuadro clínico variable, con la ausencia o subdesarrollo del músculo pectoral mayor, el tratamiento quirurgico fue personalizado para cada paciente. Las técnicas quirúrgicas incluyeron reconstrucción de la pared torácica mediante osteosíntesis en los casos graves independientemente del sexo del paciente; rotación de colgajos del músculo dorsal ancho, colocación de expansores tisulares y prótesis mamarias en el caso de las pacientes femeninas y colocación de prótesis preformadas mediante estereolitografía en el caso de los pacientes masculinos.

BACKGROUND: The Poland syndrome is an extremely rare polymalformative congenital disease, the etiology is still unknown, mainly affecting the development of the pectoralis major muscle; they are frequently accompanied by malformations of the hand, breast, nipple-areola complex, ipsilateral minor pectoral and other associated malformations. The diagnosis is based on a correct clinical examination together with a computerized axial tomography with 3D reconstruction. The final surgical treatment is individualized and will depend on the existence of one or more malformations. CASE REPORTS: Four patients with a clinical picture compatible with the Poland syndrome were treated, with underdevelopment or absence of the pectoralis major muscle being common. EVOLUTION: Each patient underwent a computerized axial tomography with 3D reconstruction to confirm their diagnosis and perform a surgical treatment according to the needs of each patient; after the procedure, patients were followed up with a favorable response and without complications. CONCLUSIONS: The Poland syndrome is characterized by a variable clinical picture, with the absence or underdevelopment of the pectoralis major muscle, the surgical treatment was customized for each patient. Surgical techniques included reconstruction of the chest wall by osteosynthesis in severe cases regardless of the sex of the patient; rotation of flaps of the latissimus dorsi muscle, placement of tissue expanders and mammary prosthesis in the case of female patients and placement of preformed prostheses by stereolithography in the case male patients.

Video Caso Clínico: Disección Aórtica Rota Tipo Stanford A. Resolución Quirúrgica: Cirugía de Bentall De Bono / Video Case Report: Rupture Aortic Dissection Stanford Type A. Surgical Resolution: Surgery Bentall and De Bono

La disección aórtica rota que compromete la raíz y la aorta ascendente es una emergencia que requiere cirugía inmediata, debido al mal pronóstico y sus complicaciones agudas: ruptura, insuficiencia aórtica aguda, hematoma intramural y endocarditis aguda; con elevadas tasas de morbilidad y mortalidad posoperatoria temprana, estimada en las 24 horas el 1 % por cada hora, a las 48 horas 29 %, en la primera semana 44 % y a las 2 semanas 50 %; con una mortalidad global de 15 % a 35 % y una sobrevida del 65 % al 75 % en un rango de 5 años [1 - 3]. En Ecuador se llevó a cabo un estudio tipo prospectivo que incluyo 120 pacientes, llevado a cabo desde 1999 a 2000, en Guayaquil; en el que reportaron 34 casos, con edad promedio de 64 años, sexo masculino, cuyo factor de riesgo más importante fue hipertensión arterial. Se presentó en el 100 % de los casos, dolor torácico transfictivo, soplo aórtico diastólico en el 70 % y solo el 2 % presentaron infarto de miocardio posteroinferior transmural sin fibrinólisis, por ser contraindicado en pacientes con disección aórtica [4]. El tratamiento quirúrgico consiste en la resección y reemplazo de la porción rota por una prótesis vascular asociada o no al reemplazo valvular aórtico dependiendo del grado de insuficiencia. El tratamiento estará orientado en función del grado de afectación de la disección y la rotura, pudiendo requerir un reemplazo convencional de la aorta ascendente (RCAA) con o sin reemplazo total del arco aórtico (RTAA); el tratamiento de elección de la disección rota tipo A es el reemplazo de la raíz y la aorta ascendente con injerto tubular valvulado, denominado procedimiento de Bentall De Bono [1 - 3, 5, 6]. Dentro de las complicaciones postquirúrgicas se encuentran: pseudoaneurisma, disección radical recurrente o residual, cambios importantes en el diámetro de la raíz o insuficiencia aórtica significativa [7]

The rupture aortic dissection that compromises the root and the ascending aorta is an emergency that requires immediate surgery; for it is poor prognosis, acute complications: rupture, acute aortic insufficiency, intramural hematoma and acute endocarditis, with high morbidity rates and early postoperative mortality, estimated at first 24 hours in 1 % per each hour, 48 hours 29 %, in the first week 44 % and at 2 weeks 50 %; with a global mortality of 15 % to 35 % and a survival of 65 % to 75 % in a range of 5 years [1-3]. In Ecuador, a prospective study realized that included 120 patients, since 1999 to 2000, in Guayaquil; in that they reported 34 cases with an average age of 64 years, male, whose most important risk factor was hypertension. The patients presented, 100 % transfictive chest pain, diastolic aortic murmur in 70 %, and only 2 % had transmural posteroinferior myocardial infarction without fibrinolysis, as it was contraindicated in patients with aortic dissection [4]. Surgical treatment consists of the resection and replacement of the broken portion by a vascular prosthesis associated or not with aortic valve replacement depending on the degree of insufficiency. The treatment will be oriented according to the degree of involvement of the dissection and rupture, and may require a conventional replacement of the ascending aorta (CRAA) with or without total aortic arch replacement (TRAA); the treatment of choice for the rupture aortic dissection type A is the replacement of the root and the ascending aorta with valvular tubular graft, called the Bentall De Bono surgery [1 - 3, 5, 6]. Of the postsurgical complications we found: pseudoaneurysm, radical or recurrent radical dissection, important changes in the diameter of the root or significant aortic insufficiency

Health Risk Impacts of Exposure to Airborne Metals and Benzo(a)Pyrene during Episodes of High PM10 Concentrations in Poland / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To check whether health risk impacts of exposure to airborne metals and Benzo(a) Pyrene during episodes of high PM10 concentrations lead to an increased number of lung cancer cases in Poland.</p><p><b>METHODS</b>In this work, we gathered data from 2002 to 2014 concerning the ambient concentrations of PM10 and PM10-bound carcinogenic Benzo(a)pyrene [B(a)P] and As, Cd, Pb, and Ni. With the use of the criterion of the exceedance in the daily PM10 mass concentration on at least 50% of all the analyzed stations, the PM10 maxima's were selected. Lung cancer occurrences in periods with and without the episodes were further compared.</p><p><b>RESULTS</b>During a 12-year period, 348 large-scale smog episodes occurred in Poland. A total of 307 of these episodes occurred in the winter season, which is characterized by increased emissions from residential heating. The occurrence of episodes significantly (P < 0.05) increased the concentrations of PM10-bound carcinogenic As, Cd, Pb, Ni, and B(a)P. During these events, a significant increase in the overall health risk from those PM10-related compounds was also observed. The highest probability of lung cancer occurrences was found in cities, and the smallest probability was found in the remaining areas outside the cities and agglomerations.</p><p><b>CONCLUSION</b>The link between PM pollution and cancer risk in Poland is a serious public health threat that needs further investigation.</p>

Síndrome de Poland. Presentación de un caso y revisión de la literatura

Se han descrito diversas alteraciones en la morfología y estructura de la glándula mamaria, como resultado de variaciones en los mecanismos reguladores de su desarrollo. La amastia es una de las anomalías congénitas de la mama menos frecuente, y consiste en la ausencia total de una o de ambas glándulas. Cuando es unilateral generalmente se acompaña también de la carencia del músculo pectoral mayor y del menor además de otro grupo de malformaciones, constituyendo así lo que se conoce como síndrome de Poland. Se presenta el caso de una adolescente de 15 años, que exhibe una ausencia congénita de la mama derecha, así como de los músculos pectorales, sin otra malformación acompañante. Es este el primer caso de síndrome de Poland diagnosticado en Cienfuegos, por lo cual se considera de interés para la comunidad científica la publicación de este reporte.

Diverse changes in the morphology and structure of the mammary gland have been described as a result of the variation of the regulatory mechanisms of its development. Amastia is one of the less frequent congenital anomalies of the breast and it consists on the total absence of one or both glands. When it is unilateral it is generally also accompanied by the lack of the major and minor pectoral muscle besides other malformations, constituting what is known as Poland Syndrome. A case of a fifteen year old female patient is presented who shows the congenital absence of the right breast. This is the first case of Poland Syndrome diagnosed in Cienfuegos, this is why the publication of this case is considered of interest for the scientific community.

Occurrence of entomopathogenic nematodes in Polish soils / Ocorrência de nematoides entomopatogênicos em solos da Polônia

ABSTRACT: Entomopathogenic nematodes ( Steinernematidaeand Heterorhabditidae) were studied in Polish soils according to the: season, habitat and altitude. In total, 167 soil samples were taken from 111 localities in Poland along north-south transect. Entomopathogenic nematodes were isolated from 53 soil samples (31.7%). Nematodes species were identified genetically from 16 samples, and in all other 37 samples nematodes were determined to the genus level. Three species of the genus Steinernema ( Steinernema kraussei, S. feltiae, S. carpocapsae) and one of the genus Heterorhabditis( Heterorhabditis megidis) were recorded. Steinernema feltiaewas the most common species. There was not a significant association between the occurrence of nematodes and season or altitude. The type of habitat significantly (P<0.05) affected the occurrence of nematodes. Nematodes were most frequent in samples collected from coniferous forests (20 findings).

RESUMO: Os nematoides entomopatogênicos ( Steinernematidaee Heterorhabditidae) foram estudados em solo polonês de acordo com estação, habitat e altitude. Foram coletadas um total de 167 amostras de solo em 111 localidades diferentes ao longo da trajeto Norte-Sul da Polônia. Os nematoides entomopatogênicos foram extraídos em 53 das amostras de solo (31,7%). As espécies de nematoides foram geneticamente identificadas a partir de 16 amostras, as outras 37 amostras foram usadas para determinar o gênero. Três espécies do gênero Steinernema( Steinernema kraussei, S. feltiae, S. carpocapsae) e uma espécie do gênero Heterorhabditis( Heterorhabditis megidis) foram identificadas. A espécie mais comum foi a S. feltiae. Não foi encontrada uma relação significativa entre a presença de nematoides com a estação do ano e a altitude. O tipo de habitat afetou significativamente (P<0,05) a ocorrência de nematoides. Os nematoides foram encontrados mais frequentemente em amostras recolhidas em florestas de coníferas (20 no total).

Síndrome de Poland: dois relatos de caso com suas respectivas condutas cirúrgicas / Poland's syndrome: two case reports with their respective surgical procedures

A Síndrome de Poland é uma anomalia congênita de baixa incidência, que afeta em média 1:32000 nascidos vivos e tem causa idiopática. Essa condição é caracterizada pela atrofia ou ausência do músculo peitoral maior, mas pode acometer também outros músculos, como o peitoral menor e serrátil. Nessa síndrome pode ocorrer associação de outros fenômenos, como a sindactilia ipsilateral, hipoplasia da mão, alterações ósseas e deformidade de Sprengel, na qual a escápula passa a ser menor e alada. No presente estudo, relatamos dois casos de Síndrome de Poland com base na revisão de prontuários. No primeiro caso, percebemos uma atrofia muscular na mama direita em que foi necessária a utilização de dois expansores para fazer a reconstrução, um na mama direita e outro na região toracoabdominal, em virtude de atrofia tecidual entre a pele e o osso. Em sequência, foi colocada a prótese mamária definitiva de silicone e foi feita a correção da atrofia tecidual. Já no segundo caso, não houve a necessidade de colocação de expansores. Em cada caso foi usada uma maneira de correção, uma vez que, nesta síndrome, não há um método único de tratar o paciente, devendo cada caso ser estudado individualmente. Com o estudo, é possível notar que a Síndrome de Poland não causa uma patologia de fato, já que na ausência do músculo peitoral maior não há comprometimentos motores, o que ocorre é um comprometimento estético(AU)

Poland 's syndrome is a congenital abnormality of low incidence, which affects roughly 1: 32,000 live births and is idiopathic. This condition is characterized by atrophy or absence of the pectoralis major muscle, but can also affect other muscles such as the pectoralis minor and serratus. This syndrome can occur in association with such other phenomena as ipsilateral syndactyly, hand hypoplasia, bone changes, and Sprengel's deformity, in which the scapula becomes smaller and winged. In the present study we report two cases of Poland's syndrome based on chart review. In the first case there was muscular atrophy in the right breast, where the use of two expanders was required for the reconstruction, one on the right breast and the other in the thoracoabdominal region, due to tissue atrophy between the skin and the bone. Subsequently, the final silicone breast implant was placed and correction of tissue atrophy was performed. In the second case there was no need for using expanders. In each case a different way of correction was used, since in this syndrome there is no single method to treat the patient, and each case should be studied individually. From this study one can see that Poland's Syndrome does not cause an actual pathology, as the absence of the pectoralis major does not bring any motor compromising; what happens is aesthetic compromising(AU)

Unilateral and Complete Agenesis of Right Pectoralis Major Muscle.

Introduction: Pectoralis major Myocutaneous flaps (PMMC) are extensively used for Head, Neck, Face and post mastectomy mammary gland reconstructive surgeries. Pectoralis major is responsible for flexion, adduction and medial rotation of shoulder joint. Its absence may obvious because of compromised movement of shoulder joint or as a part Poland’s syndrome or may be sporadic as seen in our case. Case study: Pectoralis major muscle was completely absent on right side of an adult female cadaver. Result: Complete unilateral agenesis of right Pectoralis major muscle was found in an adult female cadaver during routine undergraduate dissection in the department of Anatomy. Right Mammary gland was lying directly on hypertrophied Pectoralis minor muscle. Discussion: Awareness about absence of Pectoralis major muscle is a must for planning and success of various reconstructive surgeries, flawless interpretation of Radiographs, CT and MRI scans. Unilateral and complete agenesis of Pectoralis major muscle not associated with any other anomaly visible to naked eye as seen in our case is a rare finding and hence needs to be documented.

Secuencia de Poland, de las bases embriológicas a la práctica clínica / Poland sequence, going from the embryological bases to the clinical practice

La secuencia de Poland es un defecto congénito típicamente descrito como la ausencia congénita unilateral del músculo pectoral, que puede encontrarse asociado a la aparición de otras anomalías torácicas ipsilaterales y/o de extremidades superiores, las cuales abarcan diferentes grados de severidad funcional y de alteraciones estéticas. En la literatura se describen distintas asociaciones con diferentes síndromes, sin embargo su etiología es aún desconocida, aunque existen varias hipótesis sobre su posible causa, y es la más aceptada aquella que hace referencia a procesos de disrupción vascular. En la práctica clínica, las formas de expresión leve pueden ser ignoradas, pero en los casos más severos es requerida la atención de grupos multidisciplinarios de especialistas para su tratamiento. Se hace una revisión sistemática de la literatura sobre la secuencia de Poland.

Poland sequence is a birth defect typically described as unilateral congenital absence of the pectoralis muscle, which may be associated with the occurrence of other ipsilateral thoracic and/or upper extremities anomalies that cover different degrees of functional severity and esthetic alterations. The literature describes various types of association with different syndromes; however, its etiology remains unknown and several hypotheses about the possible cause of this disease exist, being the most accepted the one that deals with vascular disruption processes. In the clinical practice, mild forms of expression can be ignored, but in the most severe cases, the attention of a multidisciplinary group of specialists is required for disease management. A systematic literature review on Poland sequence was made.

Características por imagen del síndrome de Poland: Presentación de un caso / Imaging of Poland Syndrome: Case Report

Se conoce como síndrome de Poland a la combinación de la agenesia total o parcial del músculo pectoral mayor con una anomalía de la mano homolateral. Aunque su patogenia es incierta, se cree que deriva de una anomalía del desarrollo durante el primer trimestre de gestación. A pesar de que no existe un consenso en cuanto a su clasificación, la de Foucras es la más usada. Las imágenes juegan un papel importante desde el punto de vista diagnóstico, para confirmar, describir y clasificar el grado de hipoplasia-aplasia muscular, para orientar hacia el tratamiento quirúrgico más apropiado.

Poland syndrome is defined as a combination of total or partial agenesis of the pectoralis major muscle associated to an anomaly in the ipsilateral hand. The pathogenesis remains uncertain, it is believed that this group of malformations occurs in a developmental abnormality during the first trimester of gestation. There is no consensus about their classification. However, Foucras classification is the most used. Images play an important role to confirm and describe the grade of muscle hypoplasia-aplasia, this way, it could be classified to lead to the most appropriate surgical treatment.

Poland Syndrome in One Dizygotic Twin: A Case Report / 대한주산의학회잡지

Poland syndrome, also known as pectoral aplasia-dysdactylia syndrome, is a rare anomaly, characterized by aplasia of the pectoralis major muscle with ipsilateral upper extremity anomalies. The cause of Poland syndrome is still unknown. Several twin patients were reported to propose a genetic or nongenetic hypothesis. We experienced a female baby showing absence of the pectoralis major muscle in a pair of mixed twin. The patient was referred to our hospital for evaluation of an asymmetric chest wall. She showed depression of the left chest wall, ipsilateral nipple hypoplasia, and axillary webbing. A chest CT scan showed aplasia of the left large pectoral muscle. Our patient had no abnormalities such as symbrachydactyly in an ipsilateral upper extremity. In comparison, a physical examination showed that the fraternal twin boy was completely normal.

History of Medical Laboratory Diagnostics in Poland.

Background: Medical laboratory diagnostics in Poland has a long history, however there is lack of studies in this field. Main Findings: The first clinical laboratories on ethnic Polish territory were founded in the mid. 19th Century. After the World War I, rapid development of laboratories in Poland, similar to pan-European trends, occurred. During the World War II many laboratory professionals were killed and laboratory infrastructures were destroyed or severely damaged. In the post-WW II period, during the communist era, the development of laboratory diagnostics in Poland was not significant due to the lack of access to the latest western technologies. However, some unique solutions to some problems were developed. For example, special M.Sc. studies for laboratory staff were introduced. Towards the end of the 20th Century, in the postcommunist era, significant development of private laboratories was observed with subsequent integration into several companies. In Poland, laboratory diagnostician is a profession of public trust and over 14,000 professionals are registered in The Polish Chamber of Laboratory Diagnosticians. Conclusions: The history of medical laboratories in Poland reflects the development of this key element of healthcare. The recent history has several unique and valuable solutions as teaching laboratory staff in specific medical colleges and organizing them in associations of professionals.