Caracterización histopatológica del cáncer de vesícula en el Hospital "Joaquín Albarrán", La Habana, Cuba, en el periodo 2010-2019 / Histopathological characterization of gallbladder cancer at the "Joaquín Albarrán" Hospital, Havana Cuba, in the period 2010-2019

El cáncer de vesícula biliar es una enfermedad poco frecuente en el mundo y altamente letal. Objetivo: caracterizar histopatológicamente el cáncer de vesícula biliar en el Hospital Clínico Quirúrgico Docente "Joaquín Albarrán" de La Habana-Cuba, en el periodo 2010 al 2019. Método: se realizó un estudio retrospectivo, descriptivo y observacional, en el cual se revisaron los registros de biopsias y necropsias para identificar los casos con diagnóstico histológico de cáncer de vesícula biliar, se revisaron además tejidos fijados en parafina del archivo. Resultados: fueron diagnosticados 10 casos de cáncer de vesícula, 9 femenino y 1 masculino, todos mayores de 60 años. Histológicamente la variedad predominante fue el adenocarcinoma moderadamente diferenciado, siendo 2 de ellos mucoproductores, de los cuales 1 infiltrante y con permeación linfática. Conclusión: el cáncer de vesícula biliar es una enfermedad con muy baja frecuencia y su diagnóstico, continua siendo un hecho incidental, es decir, que el diagnóstico se establece en el examen histopatológico luego de la colecistectomía o en la necropsia. La variedad más frecuente es el adenocarcinoma moderadamente diferenciado.

Gallbladder cancer is a rare and highly lethal disease in the world. Objective: To characterize histopathologically gallbladder cancer at the "Joaquín Albarrán" Clinical Teaching Surgical Hospital of Havana-Cuba, in the period 2010 to 2019. Methods: A retrospective, descriptive and observational study was conducted, in which biopsy and necropsy records were reviewed to identify cases with a histological diagnosis of gallbladder cancer. Paraffin-embedded tissues from the archive were also reviewed. Results: Ten cases of gallbladder cancer were diagnosed, nine female and one male, all over 60 years old. Histologically the predominant variety was moderately differentiated adenocarcinoma, being 2 of them mucoproducers, of which 1 was infiltrating and with lymphatic permeation. Conclusion: Gallbladder cancer is a very low frequency disease and its diagnosis continues to be an incidental fact, that is, the diagnosis is established in the histopathological examination after cholecystectomy or in the necropsy. The most frequent variety is moderately differentiated adenocarcinoma.

LOCAL PERIARTICULAR ANALGESIA IN TOTAL KNEE ARTHROPLASTY / ANALGESIA LOCAL PERIARTICULAR NA ARTROPLASTIA TOTAL DE JOELHO

ABSTRACT Objective: To evaluate the use of infiltration of periarticular analgesic agents intraoperatively in total knee arthroplasty (TKA), with regard to benefits, reduction of pain, opioid consumption, improvement of range of motion and early ambulation. Methods: To analyze the benefits of periarticular drug infiltration, the patients submitted to TKA were evaluated, being separated into two groups. One group received the local periarticular infiltration protocol containing 0.5% bupivacaine (400mg/20ml), 1/1000 epinephrine (0.3ml), triamcinolone hexacetonide (20mg/1ml), clonidine (150mcg/1ml) and 20 ml of saline (0.9% SS) and, the other group underwent conventional intravenous analgesia. The results were compared and the variables analyzed were age, sex, BMI, comorbidities, postoperative complications, pain, functional capacity, range of motion, transfusion and rescue opioids for analgesia. Results: The mean age of the patients was 68 years and most were female and presented involvement of the left knee. Postoperatively, patients who had received periarticular infiltration showed improvement of pain as well as functional capacity. Conclusion: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery. Level of Evidence II, Prospective Comparative Study.

RESUMO Objetivo: Avaliar a realização da infiltração de solução de agentes analgésicos periarticulares no intraoperatório da artroplastia total do joelho (ATJ), no que tange aos seus benefícios, redução da dor, consumo de opioides, melhora do arco de movimento e deambulação precoce. Métodos: Para avaliar os benefícios da infiltração de agentes periarticulares, foram analisados pacientes submetidos à ATJ, sendo separados em dois grupos. Um grupo recebeu o protocolo de infiltração periarticular local, contendo solução de bupivacaína a 0,5% (400 mg /20 ml), epinefrina 1/1000 (0,3 ml), hexacetonido de triancinolona (20 mg/1 ml), clonidina (150 mcg/1 ml) e 20 ml de solução salina (SF a 0,9%) e outro grupo recebeu analgesia endovenosa convencional. Os resultados foram comparados e as variáveis analisadas foram idade, sexo, IMC, comorbidades, complicações pós-cirúrgicas, dor, capacidade funcional, amplitude de movimento, transfusão e resgate de opioides para analgesia. Resultados: Dos pacientes analisados a média de idade foi de 68 anos e a maioria era do sexo feminino e com acometimento do joelho esquerdo. No pós-operatório os pacientes que haviam recebido infiltração periarticular apresentaram melhora da dor, bem como da capacidade funcional. Conclusão: A análise dos dados obtidos demonstrou que a infiltração periarticular de agentes analgésicos é significativamente eficaz para o controle da dor e recuperação funcional. Nível de Evidência II, Estudo Prospectivo Comparativo.

Conceptos actuales de patología anorrectal funcional / Current concepts in functional anorectal disorders

The purpose of the present article is to highlight relevant aspects of anorectal pathology, mainly fiber resistant constipation, fecal incontinence and fecal soiling. A high percentage of patients with fiber resistant constipation correspond to dyssynergic defecation cases. In addition, most patients with dyssinergia and slow colonic transit return to normal after correction of the dyssyinergic condition. For these reasons, the current recommendation is to consider the evaluation of dyssynergic defecation as the initial diagnostic approach in patients with laxative-resistant constipation. Rectal hyposensitivity is an important pathophysiological mechanism involved in both constipation and fecal incontinence. About 80% of fecal incontinence cases present multiple pathological mechanisms, including sphincter insufficiency, rectal hyposensitivity, poor rectal emptying and impaired rectal compliance. Soling and seepage are usually in the context of poor rectal emptying and not in the context of sphincter insufficiency.

El siguiente artículo pretende destacar aspectos relevantes en patología anorrectal funcional, principalmente constipación resistente a fibra, incontinencia fecal y ensuciamiento. Entre los pacientes con constipación resistente a fibra, un alto porcentaje corresponde a defecación disinérgica. Además, la mayoría de los pacientes con defecación disinérgica y tránsito colónico enlentecido normalizan el tránsito tras mejoría de la disinergia. Por estos motivos, la recomendación actual es la evaluación de defecación disinérgica como primera estrategia diagnóstica en los pacientes con constipación refractaria a laxantes. La hiposensibilidad rectal es un mecanismo importante en casos de constipación e incontinencia fecal. Alrededor de 80% de los casos de incontinencia fecal tienen múltiples mecanismos descritos, incluyendo insuficiencia esfinteriana, hiposensibilidad rectal, mal vaciamiento rectal y alteraciones de la complianza rectal. El ensuciamiento suele estar en el contexto de mal vaciamiento rectal y no en el contexto de insuficiencia esfinteriana.

Evaluación del tratamiento con acetónido de triamcinolona más lidocaína para el dolor musculoesquelético en ortopedia / Evaluation of the treatment with triamcinolone acetonide plus lidocaine for musculoskeletal pain in orthopedics

Fundamento: en el año 1949, se infiltró por primera vez una articulación con cortisona en un paciente con artritis reumatoide con resultados espectaculares. Las inyecciones típicas con esteroides consisten en la combinación de un anestésico local que provee analgesia inmediata y confirmación del lugar exacto y un esteroide con acción antinflamatoria prolongada. Objetivo: evaluar los resultados de las infiltraciones con acetónido de triamcinolona en el tratamiento del dolor musculoesquelético en el Hospital Armando Enrique Cardoso de Guáimaro entre enero y junio de 2013. Método: se realizó un estudio prospectivo y analítico. La muestra no probabilística quedó constituida por 104 pacientes seleccionados según criterios. Se utilizaron las técnicas de estadísticas descriptivas e inferenciales. Resultados: prevaleció el sexo femenino con el 68, 8 % y en las edades comprendidas entre 45-64 años para un 51, 8 %. Los trabajadores y las amas de casa, fueron los más afectados y en su conjunto representaron el 84, 9 %. Dentro de las enfermedades más diagnosticadas estuvieron la periartritis escapulohumeral (28,4 %) y las lesiones del compartimiento interno de la rodilla (18, 7 %). La aplicación de la Escala Visual Análoga al final del tratamiento demostró una mejoría del dolor de más del 80 % en ambos sexos. Las complicaciones asociadas al tratamiento se presentaron solo en cinco pacientes (3 %). Conclusiones: la infiltración con acetónido de triamcinolona más lidocaína para el tratamiento del dolor musculoesquelético, brindó resultados satisfactorios con mejoría clínica rápida, sostenida y un mínimo de complicaciones.

Background: in 1949, an articulation was infiltrated with cortisone in a patient with rheumatoid arthritis for the first time with great results. Typical injections with steroids consist of the combination of a local anesthetic that provides immediate analgesia as well as confirmation of the exact area and a steroid with a prolonged anti-inflammatory action. Objective: to evaluate the results of the infiltrations with triamcinolone acetonide plus lidocaine in the treatment of musculoskeletal pain at the Armando Enrique Cardoso Hospital, Güaimaro between January and June, 2013. Method: a prospective, analytical study was conducted. The non-probabilistic sample was constituted by 104 patients selected fallowing certain criteria. Descriptive, statistical, and inferential techniques were used. Results: female sex prevailed with a 68.8 % in the ages between 45-64 years (51.8 %). Workers and housewives were the most affected and as a whole, represented the 84.9 % of the patients. Among the most frequently diagnosed diseases were scapulohumeral periarthritis (28.4 %) and lesions in the internal compartment of the knee (18.7 %). The application of a Visual Analog Scale at the end of the treatment showed an improvement of pain in more than the 80 % of the patients, in both sexes. Associate complications of the treatment were present in only five patients (3%). Conclusions: infiltrations with triamcinolone acetonide plus lidocaine for the treatment of musculoskeletal pain provided satisfactory results along with a continuous, rapid clinical improvement and a minimum of complications.

A mesoterapia melhora a amplitude articular em pacientes com tendinite do manguito rotador / Mesotherapy improves range of motion in patients with rotator cuff tendinitis

Há evidências publicadas sobre o efeito da mesoterapia para as doenças inflamatórias do ombro. Objetivo: Avaliar o ganho de amplitude de movimento (ADM) em pacientes com tendinopatia do manguito rotador tratados com mesoterapia. Uma série retrospectiva de casos conduzida a partir de prontuários médicos. Um serviço ambulatorial de reabilitação e ortopedia. População: 145 pacientes com diagnóstico clínico de tendinopatia do manguito rotador, com limitação da amplitude de movimento ativa. Método: Os sujeitos do estudo foram tratados com mesoterapia entre 1995 e 2008, a mesclas foram selecionadas de acordo com o perfil do paciente e sua tolerância. O efeito sobre a ADM foi qualificado como "sem melhora" ou "com melhora". A melhora da sintomatologia foi correlacionada com a idade, duração dos sintomas e drogas usadas na mesoterapia. A realização concomitante de fisioterapia também foi correlacionada com o desfecho. Os efeitos adversos foram avaliados sistematicamente. Resultados: 117 pacientes (80,7%) apresentaram melhor objetiva da ADM ou a dor. O resultado não foi influenciado pela idade, duração dos sintomas ou pela realização concomitante de fisioterapia. Apenas efeitos adversos menores foram observados. Conclusão: Este estudo sugere que a mesoterapia pode ser eficaz no tratamento da tendinopatia do manguito rotador, seja pela melhora da dor, ADM ou função global do membro superior. O impacto clínico deste estudo é que a mesoterapia pode ser associada ao tratamento fisioterapêutico padrão para melhorar ADM e dor na tendinopatia do manguito rotador.

There is published evidence on the effect of mesotherapy for inflammatory shoulder diseases. Objective: Evaluate the gain in range of motion (ROM) in patients with rotator cuff tendinopathy treated with mesotherapy. A retrospective series of cases conducted from medical records. Location: an outpatient rehabilitation and orthopedic service. 145 patients with clinical diagnosis of rotator cuff tendinopathy, with limited active range of motion. Method: The study subjects were treated with mesotherapy between 1995 and 2008, the blends were selected according to the patient's profile and tolerance. The effect on the ROM was qualified as "not improved" or "improved". The improvement in symptomatology was correlated to age, duration of symptoms, and drugs used in the mesotherapy. The concomitant application of physical therapy was also correlated with the result. The adverse effects were evaluated systematically. Results: 117 patients (80.7%) presented objective improvement of ROM or of pain. The result was not influenced by age, duration of symptoms, or by the concomitant application of physical therapy. Only smaller adverse effects were observed. Conclusion: This study suggests that mesotherapy can be efficient in the treatment of rotator cuff tendinopathy, for the improvement of pain, ROM, or global functioning of the upper limb. The clinical impact of this study is that mesotherapy can be associated with the standard physical therapy treatment to improve ROM and pain in rotator cuff tendinopathy.

Síndrome de Nicolau de desenvolvimento tardio: relato de caso / Late development of Nicolau syndrome: case report

A Síndrome de Nicolau, também conhecida como Embolia Cutis Medicamentosa e Dermatite Livedóide, é uma rara complicação caracterizada por necrose tecidual que ocorre após a injeção de medicamentos. Descrevemos um caso de Síndrome de Nicolau de curso tardio, posterior à infiltração intra-articular com corticóide.

Nicolau syndrome also known as Embolia cutis medicamentosa and Livedoid dermatitis is a rare complication characterized by tissue necrosis that occurs after injection of medicines. We describe a case of late development of Nicolau syndrome following intra-articular infiltration with corticosteroid.

Study of fluoride content in groundwater of Nawa Tehsil in Nagaur, Rajasthan.

There is a severe fluoride problem in Nawa tehsil of Nagaur district. Villagers are suffering from dental fluorosis and skeletal fluorosis. So an extensive geochemical study of 27 villages of eastern, south-eastern and southern zone of Nawa tehsil was done. Total 46 ground water samples were collected and analyzed for various physicochemical parameters as well as fluoride content. The ground water samples collected in clean polyethylene plastic containers were analyzed for pH, electrical conductivity, total dissolved salts, calcium, magnesium, total hardness, chloride and alkalinity. The fluoride concentration in the three different zones ranged from 0.64 to 14.62 mg l-1 where 13.04% samples were found within permissible limit while 86.96% had fluoride beyond permissible limit (> 1.5 mg l-1). It was found that among the three different zones south-eastern zone was under serious fluoride contamination where fluoride concentration ranged between 1.10 to 14.62 mg l-1. In the eastern zone fluoride concentration was recorded from 1.52 to 5.13 mg l-1 whereas in the southern zone it was found between 0.64 to 3.63 mg l-1.

CO2, Er: YAG and Nd: YAG lasers in endodontic surgery

OBJECTIVES: CO2, Er:YAG and Nd:YAG lasers have been used in endodontic surgery. This in vitro study evaluated 1 percent Rhodamine B dye penetration using computer-assisted morphometry (ImageTool Software®) of 108 endodontically treated human permanent canines. MATERIAL AND METHODS: Teeth were divided into 9 groups according to the technique used: A: 90-degree apicoectomy with bur, root-end cavity preparation with ultrasound and filled with MTA; B: 90-degree apicoectomy with bur, root-end cavity prepared with ultrasound and filled with MTA, and treatment of apical surface with CO2 laser (1 W, CW/CW); C: 90-degree apicoectomy with bur, and treatment of apical surface with Nd:YAG laser (150 mJ, 10 Hz); D: 90-degree apicoectomy with bur, and treatment of apical surface with CO2 laser,(1 W, CW/CW); E: apicoectomy with Er:YAG laser (400 mJ, 10 Hz), root-end cavity prepared with ultrasound and filled with MTA; F: apicoectomy with Er:YAG laser (400 mJ, 10 Hz) and treatment of apical surface with Nd:YAG laser (150 mJ, 10Hz); G: apicoectomy with CO2 laser (5W, CW/SP), root-end cavity prepared with ultrasound and filled with MTA; H: irradiation of apical end with CO2 laser (1 W, CW/CW); I: irradiation of apical end with Nd:YAG laser (150 mJ, 10 Hz). RESULTS: Dye penetration was found in all specimens at different rates, the lowest penetration occurring in groups C (16.20 percent), B (17.24 percent) and F (17.84 percent). CONCLUSIONS: Groups B, C and F represent the best technical sequences to perform endodontic surgery.

Avaliação, in vitro, da microinfiltração coronária na interface amálgama de prata e três materiais restauradores provisórios de uso em endodontia / In vitro evaluation of microleakage between silver amalgam and three temporary restorative materials used in endodontics

O objetivo deste estudo foi avaliar in vitro, em dentes extraídos, a microinfiltração de corante na interface material restaurador provisório (Bioplic®, Coltosol® e Tempore®) e amálgama de prata. Utilizou-se 57 terceiros molares hígidos, onde foram confeccionadas amplas restaurações de amálgama de prata. O acesso endodôntico foi realizado sobre essas restaurações, permanecendo o amálgama nas bordas. Os condutos foram esvaziados, permitindo a colocação de cones de papel. A câmara pulpar foi preenchida com algodão e sobre esta se inseriu os três diferentes materiais provisórios. Os espécimes foram impermeabilizados, submetidos à termociclagem (5ºC/55ºC) e imersos em azul de metileno 2% por 24 horas. Após, os dentes foram seccionados longitudinalmente no sentido mésio-distal. Os resultados obtidos avaliados pelo teste Kruskal-Wallis, o qual constatou que o Tempore® possuiu maiores graus de infiltração. O Bioplic® e o Coltosol® tiveram melhores resultados e não diferiram entre si. Torna-se válida a realização deste estudo, pois ocorre, freqüentemente, a necessidade da realização de acessos endodônticos em dentes restaurados com amálgama de prata.

The purpose of this study was to evaluate in vitro the microinfiltration at the interface temporary sealing material (Bioplic®, Coltosol ® and Tempore®) and silver amalgam. Fifty seven third molars were used, which were restored with silver amalgam and endodontic cavities were made. The canals were emptied, allowing the paper cone placement; the pulpar chamber filled with cotton and the referred materials were inserted. Impermeabilization and thermocycling (5ºC/55ºC)procedures were performed as well as immersion in 2% metylene blue for 24 hours. The specimens were sectioned longitudinally in mesiodistal direction and the results thus obtained were evaluated by the Kruskal-Wallis test which showed that Tempore® has greater infiltration degrees. Bioplic® and Coltosol ® obtained better results and there was no difference between them.