Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report / Cistadenoma mucinoso surgindo em istmocele uterina: relato de caso

Abstract Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world s highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.

Resumo Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.

Effect of Thymoquinone on skeletal muscle regeneration via assessment of Pax-7 and Myo-D expression in the DMBA-treated hamster pouch / Efeito da Timoquinona na regeneração muscular esquelética através da avaliação da expressão das proteínas Pax-7 e Myo-D em bolsa jugal de hamsters tratados com DMBA

Objective: Pax-7 and Myo-D regulate satellite cells' activation and differentiation, thus muscle regeneration following damage. This research aimed to investigate the effect of Thymoquinone (TQ) on skeletal muscle regeneration following 7,12-dimethylbenz-(a)-anthracene (DMBA)-induced injury in the hamster buccal pouch via immunohistochemical assessment of Pax-7 and Myo-D expression. Material and Methods: 65 male golden Syrian hamsters were divided into 3 groups: Group 1: (n=5) received no treatment. Group 2: (n=20) served as a positive control. The left buccal pouches were painted with the carcinogen 3/week/ 6weeks. Group 3: (n=40) were subdivided into two equal sub-groups as follows: Group 3a: (n=20) were given one i.p. TQ injection. Group 3b: (n=20) were given two i.p. TQ injections. Five animals from each group (2 and 3) were euthanized at 24, 48 hrs, one, and two weeks after the last injection. A blood sample (2 ml) was withdrawn for assessment of TNF-α levels in serum. Serial sections of the pouches were examined histologically (H&E), and immunohistochemically (IHC) for the detection of Pax-7 and Myo-D proteins. Results: double i.p injections of TQ resulted in a significant elevation in the level of TNF-α from the second-day post-injection with a progressive formation of the muscle fibers (MFs) and mononuclear cells (MNCs) around the deeper blood vessels. At 14 days, no statistically significant difference was found between this group and group '2', while the difference remained significant compared to groups '1' and '3a'. The muscle fibers were more mature and compact. IHC results showed positive expression of the perivascular mononuclear cells (MNCs) to both Pax-7 and Myo-D with positive reactivity of the peripheral nuclei of muscle fibers to Pax-7 compared to the negative reaction in the positive control group. Conclusion: early and two TQ injections had a promising effect on the induction of striated muscle regeneration, mainly by non-myogenic stem cells (AU)

Objetivo: Pax-7 e Myo-D regulam a ativação e diferenciação de células satélites durante a regeneração muscular pós-trauma. Assim, objetivamos investigar o efeito da timoquinona (TQ) na regeneração muscular esquelética após injúria causada por 7,12 dimetilbenzantraceno (DMBA) em bolsa jugal de hamsters, através da análise imuno-histoquímica de Pax-7 e Myo-D. Material e Métodos: 65 hamsters-sírios machos foram divididos em 3 grupos: Grupo 1: (n=5) controle negativo, sem tratamento. Grupo 2: (n=20) controle positivo. A bolsa jugal do lado esquerdo recebeu aplicação do DMBA por 3 e 6 semanas. Grupo 3: (n=40) receberam aplicação de DMBA e foram então subdivididos em: Grupo 3a: (n=20) que recebeu 1 injeção intraperitoneal (ip) de TQ e Grupo 3b: (n=20) que recebeu duas injeções ip de TQ. Cinco animais dos grupos 2 e 3 foram eutanasiados em 24 horas, 48 horas, 7 dias e 14 dias após a administração de DMBA e da última injeção de TQ. Amostras de sangue (2 ml) foram coletadas para avaliação dos níveis séricos de TNF-α. Cortes seriados da bolsa jugal dos animais foram analisados histologicamente (H&E), e através de imunohistoquimica (IHC) para avaliação das proteínas Pax-7 e Myo-D. Resultados: duas injeções ip de TQ aumentaram os níveis séricos TNF-α à partir do segundo dia pós-administração com formação progressiva de fibras musculares (MFs) e células mononucleares (MNCs) ao redor dos vasos sanguíneos. No dia 14, não houve diferença estatística entre o grupo 3b e o grupo 2, enquanto a diferença permaneceu entre o grupo 1 e 3a. As MFs apresentavam-se mais maduras e compactas. A IHC mostrou expressão de Pax-7 e Myo-D nas MNCs ao redor dos vasos, e houve expressão nuclear de Pax-7 nas MFs no grupo 2. Conclusão: ambos regimes de administração do TQ, 1 ou 2 aplicações ip, apresentaram efeito promissor na indução da regeneração muscular esquelética, principalmente nas células não-miogênicas.(AU)

Intra-abdominal desmoid tumors in familial adenomatous polyposis: How much do clinical and surgical variables interfere with their development?

Abstract Objective: Familial Adenomatous Polyposis is a complex hereditary disease that exposes the carrier to a great risk of Colorectal Cancer (CRC). After prophylactic surgery, intra-abdominal desmoid tumors are known to be one the most important cause of death. Therefore, recognition of increased-risk patients and modification of operative strategy may be crucial. Aim: The objective of this study was to estimate the desmoid tumor risk in relation to various surgical and clinical variables. Methods: Patients who had undergone polyposis since 1958 were included in the study. After exclusion criteria were met, those who had developed desmoid tumors were selected to undergo further evaluation. Results: The study revealed that the risk of developing desmoid tumors was associated with various factors such as sex ratio, colectomy, and reoperations. On the other hand, the type of surgery, family history, and surgical approach did not affect the risk of developing desmoid tumors. The data collected from 146 polyposis patients revealed that 16% had desmoid polyps. The sex ratio was 7:1, and the median age at colectomy was 28.6 years. Family history, multiple abdominal operations, and reoperations were some of the characteristics that were common in desmoid patients. Conclusion: Recognition of clinical (female sex) and surgical (timing of surgery and previous reoperations) data as unfavorable variables associated with greater risk may be useful during the decision-making process.

Transconjunctival lower eyelid blepharoplasty with "super released" orbital fat in correction of tear trough and palpebromalar groove depression / 中国修复重建外科杂志

OBJECTIVE@#To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with "super released" orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression.@*METHODS@#A clinical data of 82 patients (164 sides) with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression, who met the selection criteria between September 2021 and May 2022, was retrospectively analyzed. Of the included patients, 3 were males and 79 were females, with an average age of 34.5 years (range, 22-46 years). All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression. The deformities were graded by the Barton grading system as gradeⅠ in 64 sides, grade Ⅱ in 72 sides, and grade Ⅲ in 28 sides. The orbital fat transpositions were performed through the lower eyelid conjunctival approach. The membrane surrounding the orbital fat was completely released, allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state, which is regarded as the "super released" standard. The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space, and percutaneous fixed to the middle face. The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted.@*RESULTS@#There were 3 sides with chemosis after operation, 1 side with facial skin numbness, 1 side with mild lower eyelid retraction at the early stage after operation, and 5 sides with slight pouch residue. No hematoma, infection, or diplopia occurred. All patients were followed up 4-8 months, with an average of 6.2 months. The eyelid pouch protrusion, tear trough, and palpebromalar groove depression were significantly corrected. At last follow-up, the deformity was graded by Barton grading system as grade 0 in 158 sides and grade Ⅰ in 6 sides, with a significant difference compared to the preoperative score ( P<0.001). Patient's self-evaluation satisfaction reached very satisfied in 67 cases (81.7%), satisfied in 10 cases (12.2%), generally satisfied in 4 cases (4.8%), and dissatisfied in 1 case (1.2%).@*CONCLUSION@#The "super released" orbital fat can effectively prevent the retraction of orbital fat, reduce the probability of residual or recurrence of eyelid pouches, and improve the correction effect.

Reservoritis secundaria a infección por citomegalovirus: reporte de caso y revisión de la literatura / Pouchitis secondary to cytomegalovirus infection: Case report and literature review

Resumen La proctocolectomía total con reservorio ileal es el procedimiento quirúrgico de elección para la colitis ulcerativa refractaria (CUR) al tratamiento médico y la reservoritis es la complicación más frecuente y puede afectar hasta al 50% de los pacientes en los primeros 5 años del procedimiento. Aunque la etiología no está bien establecida, su presentación podría estar relacionada con disbiosis como resultado de la estasis fecal en individuos genéticamente susceptibles y con una respuesta inmunitaria alterada. Los síntomas típicos de reservoritis como diarrea, dolor abdominal, tenesmo, urgencia, incontinencia fecal y, menos frecuentemente, sangrado rectal no son específicos y el diagnóstico debe confirmarse mediante una evaluación endoscópica e histológica. La infección por citomegalovirus es infrecuente como causa de reservoritis; sin embargo, debe considerarse en pacientes con reservoritis refractaria al manejo antibiótico inicial. Las pruebas diagnósticas incluyen pruebas serológicas como la medición de anticuerpos, antigenemia y proteína C-reactiva (PCR) en sangre. El tratamiento de elección es el ganciclovir, medicamento de administración endovenosa que puede inducir complicaciones graves como mielosupresión, neutropenia y trombocitopenia. Se recomienda el seguimiento endoscópico posterior al tratamiento para asegurar la cicatrización mucosa, especialmente cuando hay sospecha de enfermedad de Crohn o compromiso del asa aferente en la endoscopia inicial.

Abstract Total proctocolectomy with ileal pouch is the surgical procedure of choice for ulcerative colitis refractory to medical treatment, and pouchitis is the most frequent complication. It can affect up to 50% of patients in the first five years of the procedure. Although the etiology is not well established, its manifestation could be related to dysbiosis resulting from fecal stasis in genetically susceptible individuals with altered immune responses. Typical symptoms of pouchitis, such as diarrhea, abdominal pain, tenesmus, urgency, fecal incontinence, and, less commonly, rectal bleeding, are nonspecific, and the diagnosis must be confirmed by endoscopic and histologic examination. Cytomegalovirus infection is an infrequent cause of pouchitis; however, it should be considered in patients with pouchitis refractory to initial antibiotic management. Diagnostic tests include serological tests such as the measurement of antibodies, antigenemia, and C-reactive protein (CRP) in blood. The treatment of choice is ganciclovir, an intravenous drug that can induce severe complications such as myelosuppression, neutropenia, and thrombocytopenia. Post-treatment endoscopic follow-up is recommended to ensure mucosal healing, especially when there is suspicion of Crohn's disease or involvement of the afferent loop on initial endoscopy.

TYPE I CONGENITAL COLONIC POUCH RESECTION WITH TERMINAL ILEOSTOMY IN A 43-YEAR-OLD WOMAN. CASE REPORT

INTRODUCTION: Congenital colonic pouch syndrome is an extremely rare condition, particularly in Western countries. In this condition, the colon is replaced with a partially or completely abnormal pouch, connected to the genitourinary tract by a ?stula or may end in a blind pouch. As it is a congenital condition, the cases reported are found in the neonatal population, so its detection in adulthood is extremely rare. We present the CASE PRESENTATION: case of a 43-year-old female, who was admitted to the general surgery service with suspected ?stulizing CROHN's disease. She attended with a two-month clinical picture, presenting a painful ulcer in the left perianal and gluteal region, accompanied by discharge of purulent material and feces through the vaginal introitus. Laboratory tests (CAT, colonoscopy and MRI) did not present conclusive information. An exploratory laparotomy was performed, ?nding a congenital type I colonic pouch, so it was resected, and a terminal ileostomy was performed. The present case aimed to report our experience with a CONCLUSIONS: pathology that has not been reported in this particular age group in our country. Imaging studies before surgery were unable to diagnose the pathology, so the exploratory laparotomy was decisive for the treatment.

Zenker Diverticulum: Does Size Correlate with Preoperative Symptoms?

Abstract Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life. Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD. Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1-3 cm), and large (> 3 cm). Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04). Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Clinical application of orbital ligament disruption combined with orbital septum fat release in improving facial aging / 中华医学美学美容杂志

Objective:To explore the clinical effect of the middle facial rejuvenation by cutting off the tear trough ligament and the orbicularis retaining ligament complex, opening the soft tissue spaces, combined with the lower eyelid muscle flap lateral canthus periosteum suspension and the orbital septum fat release.Methods:The clinical data of 39 patients with pouch and lacrimal groove, eyelid buccal groove depression in the Department of Cosmetic Surgery, Chongqing Chengshang Medical Beauty Clinic from June 2018 to June 2019 were retrospectively analyzed, including 2 males and 37 females, aged 30-58 (39±7) years. Through the incision of lower eyelid margin, the tear trough ligament and the orbicularis retaining ligament were completely severed. Up on the periosteum blunt, the preseptal, premaxillary and the prezygomatic spaces were dissected, and thus the fat of orbital diaphragmatic was fully expanded, by moving down and fixing on the inside, midside and outside periosteum of the inferior edge of the orbital bone. The lower eyelid muscle flap was suspended on the lateral canthus periosteum at the same time.Results:The patients were followed up for 12 months, the pouch, lacrimal groove and eyelid buccal groove depression were solved, the ptosis tissue of middle face was restored well and the effect was lasting. 3 patients felt the external eye angle traction after operation, and the symptoms disappeared 3-4 weeks later. 1 patient had mild eyelid ball separation due to hematoma organization after operation, and symptoms disappeared 3 months after anti scar treatment.Conclusions:For patients with pouch, lacrimal groove depression, eyelid buccal groove depression and midface tissue ptosis, the operation can safely and effectively solve the above problems and achieve the purpose of rejuvenation of the middle face, which is worthy of clinical application.

Mesenteric lengthening in pouch surgery: review of surgical techniques

Described for the first time in themedical literature in 1978 by Parks and Nicholls, total proctocolectomy with ileal-pouch anal anastomosis (IPAA) is nowadays the procedure of choice for patients with ulcerative colitis inwhom themedical therapy has, a selected group of patients with Crohń s disease, and for patients with familial adenomatous polyposis. Despite the advances in medical treatment regarding inflammatory bowel disease, up to 30% of patients still require surgery, and restorative proctocolectomy and IPAA are the mainstay of the surgical treatment. It is considered a demanding and technically-challenging procedure, with the main challenge being the performance of a tension-free IPAA; the main reason for failure of the tension-free anastomosis is a shortened mesentery. With particular attention to detail, sufficient length can be achieved to enable a safe anastomosis in most patients. Herein, we describe the available techniques to lengthen the mesentery of the ileal pouch to perform an easyto- reach tension-free anastomosis. (AU)

Evisceración de intestino delgado por periné posterior como presentación de hernia interrecto-vaginal: reporte de un caso / Evisceration of the small intestine through the posterior perineum aspresentation of interrecto-vaginal hernia: a case report

Introducción. El enterocele es causado por un defecto herniario del piso pélvico, siendo el más común la hernia interrecto-vaginal. Se produce por un debilitamiento del piso pélvico, por diversos factores, entre ellos, las cirugías en la región pélvica, el estreñimiento crónico o las patologías que aumentan la presión intraabdominal, el antecedente de prolapso rectal o vaginal, y también, factores congénitos. Presentación de caso. Paciente femenina de 84 años de edad, con antecedentes de un parto eutócico y múltiples procedimientos quirúrgicos, entre ellos histerectomía hace 40 años y rectosigmoidectomía por enfermedad diverticular complicada hace 6 años, quien cuatro meses antes presenta constipación crónica, que empeora en los días previos a su ingreso, con dolor perineal intenso y salida de asas intestinales a nivel de la región perineal, que la obliga a consultar a Urgencias. Al encontrarse con asas intestinales expuestas, con cambios de coloración, es intervenida quirúrgicamente con resultado satisfactorio, postquirúrgico inmediato optimo y seguimiento por consulta externa por 3 meses sin evidencia de recidiva. Discusión. La hernia interrecto-vaginal tiene una incidencia baja y una presentación clínica variada. El único tratamiento es quirúrgico

Introduction. The enterocele is produced by an hernia defect of the pelvic floor, being the most common the interrecto-vaginal hernia. It is produced by weakness of the pelvic floor for multiples factors, among them surgeries of the pelvic region, chronic constipation or pathologies that increase intra-abdominal pressure, a history of rectal or vaginal prolapse, and congenital factors. Case report. A 84-year-old female patient, with a history of eutocic delivery and multiple surgical procedures, including hysterectomy 40 years ago and rectosigmoidectomy for complicated diverticular disease 6 years ago, presented four months earlier with chronic constipation, which worsens in the days before her admission, with intense perineal pain and exit of intestinal loops at the level of the perineal region, which forced her to consult the emergency room. At examination the intestinal loops were found exposed, with color changes, she underwent surgery with satisfactory results, optimal immediate postoperative and outpatient follow-up for 3 months with no evidence of recurrence. Discussion. Interrecto-vaginal hernia has a low incidence and a varied clinical presentation. The only treatment is surgery

A Histopathological Study of Congenital Pouch Colon and its Impact on Management

Background: Congenital Pouch colon(CPC) is a rare variant of anorectal malformations (ARM) whose etiopathogenesis and management are not yet standardized. This prospective study seeks to establish the histopathological characteristics and it’s inference on the etiopathogenesis, management and prognosis of CPC. Methods: This was a prospective comparative study including all neonates with CPC and other high ARM. The excised pouch from the neonates with CPC and a strip of sigmoid colon from other high ARM patients were sent for biopsy and the histopathological features compared. Results: Histopathogical abnormalities were seen involving all the layers of the colonic pouch including mucosa, submucosa and muscularis propria. The statistically significant histopathological differences in the colonic pouch as compared to normal sigmoid colon were mucosal necrosis, focal erosions, inflammation and haemorrhage, muscularis mucosa fibrosis, submucosal congestion and haemorrhage, widening, fibrosis and presence of lymphoid follicles and circular and longitudinal muscle disarray and fibrosis. Also seen was a significant inflammatory infiltrate permeating all the layers of the pouch. Conclusion: CPC has histopathological abnormalities in all the layers of the colon. It is thus pathologically abnormal tissue. The widespread inflammatory reaction in all layers of the CPC raises the possibility of some environmental factor having a role in etiopathogenesis of CPC.

Comparison of clinical efficacy between autologous fat injection and orbital septum fat reset for infraorbital margin depression in young people / 中华医学美学美容杂志

Objective:To compare the clinical efficacy of autologous fat injection and conjunctival pedicled orbital septal fat grafting for infraorbital margin depression in young people.Methods:Fourty young patients with lower eyelid pouch and infraorbital margin depression with age of 20 to 40 years and average age of 30.6 yaers in the First Affiliated Hospital of Nanchang University from September 2017 to September 2019 were enrolled. According to the surgical method, all patients were divided into 2 groups with 20 cases each. Group 1 underwent transconjunctival orbital septum fat reset. Group 2 underwent various autologous fat injection after proper amount of orbital septal fat being removed, including structural fat, fine-particle fat and nano-fat, performed in different parts and layers. The tear trough rating scale (TTRS) scores and patients＇ satisfaction at 1 year after operation between 2 groups were compared.Results:Compared with the preoperative TTRS scores, the differences in scores at 6 months and 1 year after surgery were statistically significant ( P<0.01). The scores between two groups were compared at 6 months and 1 year respectively after the operation, and the difference were both statistically significant ( P<0.01). 6 months after the operation, the TTRS scores including four items were carefully compared between the two groups. It showed that the reduction of tear groove depth ( P<0.05), pigmentation ( P<0.01) and wrinkle ( P<0.01) in group 2 were more obvious than those in group 1. The percentage of satisfaction in group 2 (95%) was higher than that in the group 1 (70%), and the difference was statistically significant ( P<0.01). Conclusions:For infraorbital margin depression of young people, after proper amount of orbital septal fat being removed, various free fats graft injection into different parts and layers could obtain better treatment results, reducing not only the depth of the tear groove, but also periorbital pigmentation and fine wrinkles.

Evisceración del intestino delgado estrangulado en una anciana con douglascele / Evisceration of the impacted small bowel in an elderly with douglascele

Se presenta el caso clínico de una anciana de 86 años de edad con evisceración del intestino delgado a través del periné. Se efectuó la exploración quirúrgica urgente del abdomen y se observó la perforación del fondo del saco de Douglas y la salida de 50 cm de intestino delgado estrangulado, de manera que se realizó la resección intestinal de todo el segmento afectado y anastomosis termino-terminal. Luego se reparó el defecto del fondo del saco de Douglas con una plastia perineal, para lo cual se utilizó una malla de polipropileno. Este proceder es una buena alternativa para el tratamiento quirúrgico en quienes presentan hernias perineales, pues permite un cierre mejor, disecar el saco herniario y reducirlo adecuadamente.

The case report of a 86 years elderly is presented with evisceration of the small bowel through the perineum. The urgent surgical exploration of the abdomen was carried out and it was observed the perforation of the Douglas pouch and the 50 cm prominence of impacted small bowel, so that the bowel resection of the whole affected segment and end to end anastomosis was carried out. Then the Douglas pouch defect was repaired with a perineal plasty, for which a polypropylene mesh was used. This procedure is a good alternative for the surgical treatment in those who present perineal hernias, because it allows a better closing, to dissect the hernial sack and to reduce it appropriately.

Tortícolis como forma de presentación de quiste de la bolsa de Blake. Diagnóstico ecográfico en atención primaria / Torticolis as a form of presentation of Blake's pouch cyst. Ultrasound diagnosis in primary care

La tortícolis es un signo clínico definido por la inclinación lateral del cuello y rotación de la cabeza, que puede ser fija o flexible y acompañarse o no de dolor cervical. Aparece en trastornos de diferente complejidad. Ante un caso de tortícolis, es preciso realizar una historia clínica cuidadosa y un examen físico completo, y, en caso de ser persistente, solicitar pruebas de imagen.Se hace referencia a una causa de tortícolis no descrita en la literatura. Se trata de una tumoración quística compresiva en la fosa craneal posterior, quiste de la bolsa de Blake, en una lactante pequeña diagnosticada mediante ecografía en la consulta de Pediatría de Atención Primaria. Tras el diagnóstico, se remitió al centro hospitalario de referencia, donde se intervino de urgencia por Neurocirugía Pediátrica, mediante fenestración de la tumoración por ventriculostomía endoscópica y derivación ventrículo-peritoneal. Actualmente, se encuentra asintomática y sin secuelas.

Torticollis is a clinical sign defined by the lateral inclination of the neck and rotation of the head, which can be fixed or flexible and accompanied or not by cervical pain. It appears in disorders of different complexity. In a case of torticollis it is necessary to carry out a careful medical history and a complete physical examination and, if persistent, request imaging tests.Reference is made to a cause of torticollis not described in the literature. This is a compressive cystic tumor in the posterior cranial fossa, Blake's pouch cyst, in a small infant diagnosed by ultrasound in the Primary Care Pediatrics office. After diagnosis, she was referred to the referral hospital, where emergency intervention was performed by pediatric neurosurgery, by fenestration of the tumor by endoscopic ventriculostomy and ventriculo-peritoneal shunt. She is currently asymptomatic and without sequelae.

Correlation of periodontal parameters to various types of smokeless tobacco in tobacco pouch keratosis patients: A cross-sectional study

Background: Tobacco practice in relation with oral diseases is a foremost cause for the global oral disease burden and is accountable for up to 50% of all periodontitis cases among adults. The present cross-sectional study was undertaken to evaluate the local effects of various types of smokeless tobacco on periodontal health in tobacco pouch keratosis (TPK) patients in Mangalore city in the state of Karnataka. Materials and Methods: A total of 345 TPK patients were evaluated of which all were smokeless tobacco users. All the patients were clinically examined for different clinical periodontal parameters such as stains, gingival recession (GR), periodontal pocket, furcation involvement, and mobility and local effects of various types of smokeless tobacco on periodontal health in TPK sites were recorded. Results: The prevalence of GR was of 87.5%. Haathichaap was the most common smokeless tobacco used (35.9%) closely followed by nonpackaged type (loose tobacco) (19.4%). This was followed by Madhu (14.2%). Likewise, periodontal parameters were observed more in these patients in decreasing order. Conclusion: The results of the present study agree strongly with other smokeless tobacco user studies in terms of the strong association between GR and smokeless tobacco placement. The present cross-sectional study indicates that TPK lesions are positively associated with periodontal diseases. It is important to raise awareness of both oral cancer and periodontal risks and inform about its possible health consequences thereby working towards an improvement of oral and general health and related quality of life in these patients

A rare case of obstructive ileus due to ileal pouch torsion: a case report and systematic review

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the standard surgical treatment for ulcerative colitis patients. Among others, it is important for clinicians to be aware of a rare, though urgent situation, the ileal pouch torsion. A high degree of suspicion is essential as obstruction due to pouch torsion is not likely to resolve conservatively. Delay in diagnosis and treatment can lead to pouch jeopardy and life-threatening complications. The aim of this study was to present a systematic review of the literature combined with the presentation of a case report of our department regarding this rare entity. A systematic literature review according to QUORUM guidelines was conducted in July 2019 using MEDLINE, SCOPUS, and COCHRANE databases. We included studies reporting pouch torsion after IPAA in English or German language with no restriction regarding publication time.  Outcomes after different treatment options, such as operative pouch detorsion, and/or pouchpexy, and/or pouch reconstruction, and/or end-ileostomy through laparoscopic or open procedures were evaluated. We identified 170 publications. After duplicates and irrelevant articles have been excluded, 25 publications remained for full-text review. Finally, 12 articles were included in this systematic review, concerning 14 cases. To the best of our knowledge, this is the first comprehensive systematic review on this topic to date.

Developmental Anomalies And Morphological Variations Of Gall Bladder- A Cadaveric Study

The present study aimed at clinical evalution of dexmedetomidine 10 microgm, as an adjuvant to heavy bupivacaine 0.5% (4 ml) in subarachnoid block in patients scheduled for lower abdominal surgeries. Total no. of patients included in the study are 66 who are admitted in orthopaedic ward for lower limb surgeries, who are of ASAgrade I & II and age group between 18-60yrs. All the routine investigations of the patients were done and after complete PAC and preoperative preparations, patients were taken into O.T, all the standard monitoring applied and for subarachnoid block hyperbaric Bupivacaine 0.5% is a dose of 4ml (20mg) combined with or without Dexmedetomidine was administrated according to the assigned study group: 1.Group A- Inj. Bupivacaine- 20mg alone- control group 2.Group B- Inj. Bupivacaine- 20mg with Dexmedetomidine 10mcg-study group Data on onset & offset of sensory & motor block, degree of muscle relaxation, postoperative pain free period were recorded. Dermatome level of block, vitals & drug related complications were also noted. On the basis of observations, following conclusions are drawn: Rapid onset & increased duration of sensory block was seen in Grp B, Onset of motor block & post operative pain free period was prolonged in Grp. B. Sedation score was from 0-2 in study group.Other complications in study group were not significant.

Comparing the degree of pelvic pain with the macroscopic features of endometriosis

Background: Endometriosis is considered as the chronic benign gynecologic disease which can cause chronic pelvic pain (CPP) and infertility. Endometriosis has affected almost 10% of the women of reproductive age.Methods: Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously.Results: Mean age of women with endometriosis was 30±5.75 years. Majority had superficial implants (30%), 6.66% had deep implants and 6.66% had combination of superficial and deep implants. There was no significant difference between implants and severity of pain (p=0.069). There was a significant association between severity of pain with obliteration of POD. Significant association was seen between deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration and severity of pain.Conclusions: Severity of pain was significantly associated with deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration. However, no association was obtained between severities of pain with superficial implants.

Lo mejor del Congreso Uruguayo de Cardiología 2018 / The best of the 2018 Uruguayan Congress of Cardiology / O melhor do Congresso Uruguaio de Cardiologia 2018

Resumen: El 34° Congreso Uruguayo de Cardiología, celebrado en Montevideo del 2 al 4 de diciembre del pasado año, nuevamente destacó por las excelentes presentaciones de los temas más relevantes del ámbito cardiológico, así como también por sus invitados de renombre, nacionales e internacionales. Acompañando el gran nivel del Congreso se expusieron 32 temas libres que abarcaron diferentes áreas de la cardiología de los cuales comentaremos cuatro trabajos premiados: - Riesgo de trombosis en bioprótesis aórtica y eventos clínicos según uso de anticoagulación. Metaanálisis de la evidencia actual. - Uso de NT-ProBNP como predictor de evolución en el posoperatorio de cirugía cardíaca. - Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico. - Incidencia de troponina T ultrasensible en rango anormal y su correlación con la anatomía coronaria en pacientes en valoración por enfermedad coronaria estable.

Summary: The 34th Uruguayan Congress of Cardiology, celebrated last year in Montevideo from December 2nd to 4th, again stood out for the excellent presentations of the most relevant topics in the field of cardiology, as well as for its renowned national and international guests. Accompanying the great level of the Congress, 32 articles that covered different topics in the cardiological area were presented, of which we will comment four awarded: - Risk of thrombosis in aortic bioprosthesis and clinical events according to the use of anticoagulation. Meta-analysis of current evidence. - Use of NT-ProBNP as a predictor of evolution in the postoperative period of cardiac surgery. - Prevalence of septal pouch in a cohort derived for transesophageal echocardiography. - Incidence of ultrasensitive troponin T in abnormal range and its correlation with coronary anatomy in patients in assessment for stable coronary disease.

Resumo: O 34º Congresso Uruguaio de Cardiologia, realizado em Montevidéu entre os dias 2 e 4 de dezembro no ano passado, voltou a destacar-se pelas excelentes apresentações dos temas mais relevantes no campo da cardiologia, bem como por seus renomados convidados, nacionais e internacionais. Acompanhando o grande nível do Congresso, tinham 32 temas livres que cobriam diferentes áreas da cardiologia, dos quais comentaremos quatro artigos premiados: - Risco de trombose na bioprótese aórtica e eventos clínicos de acordo com o uso de anticoagulação. Meta-análise da evidência atual. - Uso de NT-ProBNP como preditor de evolução no pós-operatório de cirurgia cardíaca. - Prevalência de bolsa septal em uma coorte derivada para ecocardiografia transesofágica. - Incidência de troponina T ultrassensível em faixa anormal e sua correlação com a anatomia coronariana em pacientes em avaliação para doença coronariana estável.