Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap / Reparo de fístulas faringocutâneas pós-laringectomia utilizando retalho do músculo peitoral maior

Abstract Introduction: The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results. Methods: We retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients. Results: There were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed. Conclusions: The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.

Resumo Introdução: O retalho do músculo peitoral maior é uma opção a ser considerada no fechamento de fístula faringocutânea pós-laringectomia total. Não há grandes estudos que avaliem as variáveis relacionadas à recorrência da fístula faringocutânea após esse procedimento. Nossos objetivos foram avaliar os resultados obtidos com esse tipo de tratamento em pacientes laringectomizados com fístula faringocutânea e as variáveis relacionadas aos resultados. Método: Revisamos retrospectivamente os nossos resultados em 50 pacientes nos quais um retalho miocutâneo ou fasciomuscular do músculo peitoral maior foram utilizados para reparar a fístula faringocutânea. Resultados: Não houve casos de necrose de retalho. Após o reparo da fístula com um retalho do músculo peitoral maior, a ingestão oral foi restaurada em 94% dos casos. Houve recorrência da fístula em 22 casos (44%), a qual foi associada à duração da hospitalização. O uso do retalho como procedimento de emergência foi associado a um risco significativamente maior de recorrência da fístula. A permanência hospitalar foi significativamente menor quando utilizado um tubo de derivação salivar. Conclusões: O uso do retalho do músculo peitoral maior é uma abordagem útil para reparar a fístula faringocutânea. A colocação de tubos de derivação salivar durante o reparo da fístula reduz significativamente o tempo de hospitalização e a gravidade das complicações em caso de recorrência da fístula faringocutânea.

Parotid Incidentaloma Identified by Positron Emission/Computed Tomography: When to Consider Diagnoses Other than Warthin Tumor

Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor. Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology. Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case. Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4% . The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients. Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers. .

Prediabetes y diabetes sin asociación con obesidad en jóvenes mexicanos / Pre-diabetes and diabetes without association with overweight or obesity in Mexican youth

El propósito de este estudio fue identificar la prevalencia de prediabetes y diabetes en jóvenes e nuevo ingreso a una universidad y la relación de estos datos con los índices antropométricos. Participaron 3559 estudiantes, 2257 (61,43%) mujeres ( 18,58 años) y 1725 (36,59%) hombres ( 18,76 años). Se midieron los índices de masa corporal, cintura cadera y cintura talla. Se determinaron glucosa en ayunas, triglicéridos, colesterol total y lipoproteínas de baja y alta densidad. Se hicieron pruebas de razón de posibilidades (RP) y de intervalo de confianza al 95%. Hubo una elevada proporción de sobrepeso-obesidad combinados, 42,29% de mujeres y 52,45% en hombres. Se encontró que ± 10% de mujeres y hombres presentaron glucosa ≥ 5,6 mmol/L (prediabetes) y que ± 1,5% de mujeres y hombres tuvo glucosa ≥ 7 mmol/L (diabetes) sin que se encontrara relación entre este dato y el óndice de masa corporal (RP 0.97 para mujeres y 1,08 para hombres), cintura cadera (RP 1,7 en mujeres y 0.8 en hombres) o cintura talla (RP 1,1 en mujeres y 1,19 en hombres). Hubo triglicéridos elevados en 13,55% de mujeres y 21,04% de hombres y nivel bajo de lipoproteínas de alta densidad en 16% de mujeres y 10% de los hombres. Se encontró que en estos jóvenes la capacidad predictiva de los tres parámetros antropométricos se limitó a triglicéridos en mujeres y hombres (RP 2,4 en mujeres y 3,86 en hombres) y lipoproteínas de alta densidad disminuidas en mujeres (RP 0,42).

The purpose of this study was to identify the prevalence of prediabetes and diabetes in young in new college students and the relationship of these data with anthropometric indexes. 3559 students took part, 2257 (61,43 %) women ( 18,58 years) and 1725 (36,59%) men ( 18,76 years). Body mass index were measured up as well as waist hip ratio and waist height ratio. Fasting blood glucose, triglycerides, total cholesterol, low and high density lipoproteins were determined. Odds ratio (OR) and 95% confidence intervals were determined. There was a high proportion of overweight-obesity combined, 42,29% women and 52,45% men. They were founds ± 10% of women and men that presented glucose ≥ 5,6 mmol/L (prediabetes) and ± 1% of women and men that had glucose ≥ 7 mmol/L (diabetes). No relationship was found between this data and body mass index (OR 0,97women and 1.08 men), waist hip ratio (OR 1,7 women and 0.8 men) or waist height ratio (OR 1,1 women and 1.19 men). There was elevated triglycerides in 13,55% of women and 21,04% of men and a low level of high density lipoprotein in 16% of women and 10% of men. We found that in these young people the predictive power of the three anthropometric parameters was limited to triglycerides in women and men (OR 2,4 and 3.86) and low high density lipoproteins in women (OR 0,42).

Distribución geográfica de casos de fiebre de dengue en zonas anegadas de Villahermosa, Tabasco, México, 2010 / Geographic distribution of dengue fever cases in flooded zones from Villahermosa, Tabasco, in 2010

Objective: To describe the geographical distribution of dengue fever cases in flooded areas of Villahermosa, Tabasco, in 2010. Methods: Cross-sectional, descriptive study. Universe: Colonies with antecedents of flooding during the inundation of the State, located in Villahermosa, Tabasco: Gaviotas Norte, Gaviotas Sur, La Manga 1th Section, La Manga 2nd Section and La Manga 3th Section. Convenience sample without randomization. Variables: location, dengue fever case. Analysis: descriptive statistic. Software: SPSS version 11.0. Results: 540 individuals were included. The distribution was: Gaviotas Norte, 36.1%; Gaviotas Sur, 24.8%; La Manga 1th Section, 13.8%; La Manga 2nd Section, 13.2%; and La Manga 3th Section, 12.1%. We found three cases with positive serology of IgG (0.6%) and five cases of positive IgM (0.9%). The geographical distribution was associated with the proximity to two water bodies: Rio Grijalva and Laguna El Encanto. Conclusions: It is necessary to reinforce preventive interventions in the proximity of bodies of fresh water.

Objetivo: Describir la distribución geográfica de los casos de fiebre de dengue en zonas anegadas de Villahermosa, Tabasco, México, en el año 2010. Métodos: Estudio transversal, descriptivo. Universo en estudio: colonias con antecedentes de anegación durante las inundaciones del Estado, ubicadas en Villahermosa, Tabasco: Gaviotas Norte, Gaviotas Sur, La Manga 1ª Sección, La Manga 2ª Sección y La Manga 3ª Sección. Muestra: no probabilís-tica por conveniencia. Variables: ubicación, caso de fiebre de dengue. Análisis: estadística descriptiva. Software: SPSS versión 11.0. Resultados: Se incluyeron 540 sujetos, distribuidos en Gaviotas Norte 36,1%; Gaviotas Sur 24,8%; La Manga 1a Sección 13,8%; La Manga 2a Sección 13,2%; La Manga 3a Sección 2,1%. Se encontraron tres casos con serología positiva a IgG (0,6%) y cinco casos con serología positiva a IgM (0,9%). La distribución geográfica de los casos guardó relación con la cercanía a dos cuerpos de agua: Río Grijalva y Laguna El Encanto. Conclusiones: Es necesario reforzar las intervenciones preventivas en zonas cercanas a cuerpos de agua dulce.