Prevalencia de complicaciones posquirúrgicas en pacientes sometidos a reparación quirúrgica de hernias inguinales

RESUMEN La hernia inguinal es una enfermedad frecuente no exenta de complicaciones. Con el objetivo de determinar la prevalencia de las complicaciones posquirúrgicas en pacientes con hernia inguinal; se realizó un estudio cuantitativo, transversal y descriptivo en un universo de 86 pacientes intervenidos quirúrgicamente por hernia inguinal en el año 2019; Hospital General Mariano Pérez Balí, Granma. Se evaluaron las variables: edad, sexo, tipo de hernia inguinal, lateralidad, técnica quirúrgica y complicaciones constatadas. En un total de 86 pacientes con hernia inguinal la edad media fue de 53,81 años. El sexo masculino representó el 95,34 % del total de pacientes, las hernias tipo II de Nyhus representaron el 46,24 %. Las técnicas de hernioplastias fueron empleadas en la reparación del 54,84 % del total de hernias reparadas particularmente la técnica de Lichtenstein. El 66,66 % de las hernias inguinales sometidas a reparación quirúrgica no presentaron complicaciones mientras que el 11,83 % se complicaron de forma aguda con funiculitis. Se concluye que la incidencia de las complicaciones posquirúrgicas en la hernia inguinal fue elevada.

ABSTRACT Inguinal hernia is a common disease not free of complications. In order to determine the prevalence of postoperative complications in patients with inguinal hernia; a quantitative, cross-sectional and descriptive study was carried out in a universe of 86 patients who underwent surgery for inguinal hernia in 2019; Mariano Pérez Balí General Hospital, Granma. The variables were evaluated: age, sex, type of inguinal hernia, laterality, surgical technique and verified complications. In a total of 86 patients with inguinal hernia the mean age was 53,81 years. Male sex represented 95,34 % of all patients, Nyhus type II hernias represented 46,24 %. Hernioplasty techniques were used to repair 54,84 % of all hernias repaired, particularly the Lichtenstein technique. The 66,66 % of the inguinal hernias undergoing surgical repair did not present complications while 11,83 % were acutely complicated with funiculitis. It isconcluded that the incidence of postoperative complications in inguinal hernia was high.

RESUMO A hérnia inguinal é uma doença frequente que não está isenta de complicações. A fim de determinar a prevalência de complicações pós-operatórias em pacientes com hérnia inguinal; foi realizado um estudo quantitativo, transversal e descritivo em um universo de 86 pacientes submetidos à cirurgia de hérnia inguinal em 2019; Hospital Geral Mariano Pérez Balí, Granma. Foram avaliadas as variáveis: idade, sexo, tipo de hérnia inguinal, lateralidade, técnica cirúrgica e complicações encontradas. Em um total de 86 pacientes com hérnia inguinal, a média de idade foi de 53,81 anos. O sexo masculino representou 95,34% do total de pacientes, as hérnias tipo II de Nyhus representaram 46,24%. As técnicas de hernioplastia foram utilizadas no reparo de 54,84% de todas as hérnias reparadas, principalmente a técnica de Lichtenstein. 66,66% das hérnias inguinais foram submetidas a correção cirúrgica sem complicações, enquanto 11,83% foram agudamente complicadas com funiculite. Conclui-se que a incidência de complicações pós-operatórias em hérnia inguinal foi alta.

Prevalencia de complicaciones posquirúrgicas en pacientes sometidos a reparación quirúrgica de hernias inguinales / Prevalence of postoperative complications in patients undergoing surgical repair of inguinal hernias

La hernia inguinal es una enfermedad frecuente no exenta de complicaciones. Con el objetivo de determinar la prevalencia de las complicaciones posquirúrgicas en pacientes con hernia inguinal; se realizó un estudio cuantitativo, transversal y descriptivo en un universo de 86 pacientes intervenidos quirúrgicamente por hernia inguinal en el año 2019; Hospital General Mariano Pérez Balí, Granma. Se evaluaron las variables: edad, sexo, tipo de hernia inguinal, lateralidad, técnica quirúrgica y complicaciones constatadas. En un total de 86 pacientes con hernia inguinal la edad media fue de 53,81 años. El sexo masculino representó el 95,34 por ciento del total de pacientes, las hernias tipo II de Nyhus representaron el 46,24 por ciento. Las técnicas de hernioplastias fueron empleadas en la reparación del 54,84 por ciento del total de hernias reparadas particularmente la técnica de Lichtenstein. El 66,66 por ciento de las hernias inguinales sometidas a reparación quirúrgica no presentaron complicaciones mientras que el 11,83 por ciento se complicaron de forma aguda con funiculitis. Se concluye que la incidencia de las complicaciones posquirúrgicas en la hernia inguinal fue elevada(AU)

Inguinal hernia is a common disease not free of complications. In order to determine the prevalence of postoperative complications in patients with inguinal hernia; a quantitative, cross-sectional and descriptive study was carried out in a universe of 86 patients who underwent surgery for inguinal hernia in 2019; Mariano Pérez Balí General Hospital, Granma. The variables were evaluated: age, sex, type of inguinal hernia, laterality, surgical technique and verified complications. In a total of 86 patients with inguinal hernia the mean age was 53,81 years. Male sex represented 95,34 percent of all patients, Nyhus type II hernias represented 46,24 percent. Hernioplasty techniques were used to repair 54,84 percent of all hernias repaired, particularly the Lichtenstein technique. The 66,66 percent of the inguinal hernias undergoing surgical repair did not present complications while 11,83 percent were acutely complicated with funiculitis. It isconcluded that the incidence of postoperative complications in inguinal hernia was high(EU)

Diagnosis, management and mortality in acute aortic syndrome: results of the Spanish Registry of Acute Aortic Syndrome (RESA-II).

BACKGROUND: Recent advances in the diagnosis and treatment of acute aortic syndrome should improve the outcome of this disease. The Spanish Registry of Acute Aortic Syndrome aimed to assess current results in acute aortic syndrome management in a wide cohort of hospitals in the same geographical area. METHODS: From January 2012 to January 2014, 26 tertiary hospitals included 629 consecutive patients with acute aortic syndrome: 73% men, mean age 64.7±14 years (range 22-92), 443 type A (70.4%) and 186 type B (29.6%). RESULTS: Time elapsed between symptom onset and diagnosis was <12 hours in 70.7% of cases and <24 hours in 84.0% (median 5 hours; 25th-75th percentiles, 2.7-15.5 hours). Computed tomography was the first diagnostic technique in 78% of patients and transthoracic echocardiography in 15%. Surgical treatment was indicated in 78.3% of type A acute aortic syndrome. The interval between diagnosis and surgery was 4.8 hours (quartile 1-3, 2.5-11.4 hours). Among the patients with type B acute aortic syndrome, treatment was medical in 116 cases (62.4%), endovascular in 61 (32.8%) and surgical in nine (4.8%). Type A mortality during hospitalisation was 25.1% in patients treated surgically and 68% in those treated medically. Mortality in type B was 13.8% in those with medical treatment, 18.0% with endovascular therapy and 33.0% with surgical treatment. CONCLUSION: Improvements in the diagnosis and treatment of acute aortic syndrome have not resulted in a significant reduction in hospital mortality. The results of this study reflect more overall and less selected information on acute aortic syndrome management and the need for sustained advances in the therapeutic strategy of acute aortic syndrome.

Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan / Aspergilosis diseminada en un paciente inmunocompetente con bis(metiltio)gliotoxina detectable y galactomanano negativo

Background. Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients. Case report. A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started. Conclusions. Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts (AU)

Antecedentes. La aspergilosis diseminada invasiva es un hallazgo excepcional en pacientes inmunocompetentes, y al igual que en los pacientes inmunodeficientes, alcanza valores de mortalidad elevados. Para el correcto manejo del paciente son necesarios métodos diagnósticos precoces. La bis(metiltio)gliotoxina es un nuevo biomarcador de gran utilidad en pacientes oncohematológicos. Caso clínico. Varón de 70 años de edad con diabetes mellitus tipo II no dependiente de insulina y antecedente de recambio valvular aórtico con by-pass coronario cinco años antes, que acude al Servicio de Urgencias por visión borrosa. Tres días después se le diagnosticó endoftalmitis endógena en la consulta de Oftalmología. Durante su ingreso para la vitrectomía presentó una isquemia del miembro inferior derecho. La tomografía computarizada de tórax reveló un aneurisma micótico en la aorta torácica ascendente y un trombo parietal. Se reemplazó la aorta ascendente y se eliminó abundante material friable de aspecto infeccioso entre la prótesis valvular aórtica y el aneurisma. En los cultivos de humor vítreo y aorta creció Aspergillus fumigatus sensu stricto. Se detectó bis(metiltio)gliotoxina en dos muestras de suero obtenidas antes del tratamiento antifúngico intravenoso, marcador que disminuyó tras comenzar el tratamiento con voriconazol. Conclusiones. La aspergilosis diseminada invasiva es una enfermedad grave independientemente del estado inmune del paciente. Este caso clínico evidencia que la bis(metiltio)gliotoxina podría ser un marcador diagnóstico precoz no solo en pacientes neutropénicos, sino también en huéspedes inmunocompetentes (AU)

Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan.

BACKGROUND: Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients. CASE REPORT: A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started. CONCLUSIONS: Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts.

Local root abscisic acid (ABA) accumulation depends on the spatial distribution of soil moisture in potato: implications for ABA signalling under heterogeneous soil drying.

Patterns of root abscisic acid (ABA) accumulation ([ABA]root), root water potential (Ψroot), and root water uptake (RWU), and their impact on xylem sap ABA concentration ([X-ABA]) were measured under vertical partial root-zone drying (VPRD, upper compartment dry, lower compartment wet) and horizontal partial root-zone drying (HPRD, two lateral compartments: one dry, the other wet) of potato (Solanum tuberosum L.). When water was withheld from the dry compartment for 0-10 d, RWU and Ψroot were similarly lower in the dry compartment when soil volumetric water content dropped below 0.22cm(3) cm(-3) for both spatial distributions of soil moisture. However, [ABA]root increased in response to decreasing Ψroot in the dry compartment only for HPRD, resulting in much higher ABA accumulation than in VPRD. The position of the sampled roots (~4cm closer to the surface in the dry compartment of VPRD than in HPRD) might account for this difference, since older (upper) roots may accumulate less ABA in response to decreased Ψroot than younger (deeper) roots. This would explain differences in root ABA accumulation patterns under vertical and horizontal soil moisture gradients reported in the literature. In our experiment, these differences in root ABA accumulation did not influence [X-ABA], since the RWU fraction (and thus ABA export to shoots) from the dry compartment dramatically decreased simultaneously with any increase in [ABA]root. Thus, HPRD might better trigger a long-distance ABA signal than VPRD under conditions allowing simultaneous high [ABA]root and relatively high RWU fraction.

Two potato (Solanum tuberosum) varieties differ in drought tolerance due to differences in root growth at depth.

To test the hypothesis that root growth at depth is a key trait explaining some genotypic differences in drought tolerance in potato (Solanum tuberosum L.), two varieties (Horizon and Maris Piper) differing in drought tolerance were subjected to different irrigation regimes in pots in a glasshouse and in the field under a polytunnel. In the glasshouse, both cultivars showed similar gas exchange, leaf water potential, leaf xylem ABA concentration and shoot biomass independently of whether plants were grown under well watered or water deficit conditions. Under well watered conditions, root growth was three-fold higher in Horizon compared with Maris Piper, 3 weeks after emergence. Water deficit reduced this difference. In the polytunnel, applying 60% or less irrigation volume compared with full irrigation significantly decreased tuber yield in Maris Piper but not in Horizon. This was coincident with the higher root density of Horizon in deep soil layers (>40cm), where water content was stable. The results suggest that early vigorous root proliferation may be a useful selection trait for maintaining yield of potato under restricted irrigation or rainfall, because it rapidly secures access to water stored in deep soil layers. Although selecting for vigorous root growth may assist phenotyping screening for drought tolerance, these varieties may require particular environmental or cultural conditions to express root vigour, such as sufficiently deep soils or sufficient water shortly after emergence.

Trasplante cardiaco en presencia de vena cava superior izquierda y agenesia de vena cava superior derecha / Cardiac transplantation in a patient with a persistent left superior vena cava and an absent right superior vena cava

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Fiebre de origen desconocido e ictericia como presentación clínica de mixoma de aurícula derecha / Fever of unknown origin and jaundice as the clinical presentation of myxoma of the right atrium

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Leiomiomatosis intravascular: el desafío quirúrgico de los tumores con extensión cavoauricular / Intravascular leiomyomatosis: the surgical challenge of tumors with cavoatrial extension

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Tratamiento quirúrgico de la fibrosis endomiocardica: a propósito de un caso / Endomyocardial fibrosis surgical treatment: a case report

La fibrosis endomiocárdica es una miocardiopatía restrictiva progresiva de origen desconocido más comúnmente frecuente en países tropicales. Está caracterizada por una fibrosis progresiva y un engrosamiento del endocardio ventricular, muchas veces asociada a insuficiencia de las válvulas auriculoventriculares. El tratamiento quirúrgico consiste en la decorticación del endocardio ventricular y recambio o reparación de las válvulas auriculoventriculares. La operación es el tratamiento de elección a causa del severo pronóstico progresivo y de la inefectividad del tratamiento médico. La cirugía pudiera tener un efecto beneficioso en comparación con el tratamiento médico en pacientes en clase funcional III y IV. Presentamos nuestra experiencia con una cirugía correctiva realizada sobre esta lesión llevada a cabo sobre un joven originario de Guinea

Endomyocardial fibrosis is a progressive restrictive endocardial disease of unknown origin more commonly ocurring in tropical countries. This is characterized by progressive fibrosis and thickening of the ventricular endocardium, often associated with atrioventricular valve incompetence. The surgical treatment consists of decortication of the ventricular endocardium and replacement or repair of the atrioventricular valve. Operation seems to be the treatment of choise because endomyocardial fibrosis is characterized by a grave prognosis and medical therapy is ineffective. Surgery could have a beneficial effect over medical treatment in class III and IV patients. We present our experience with a corrective operation of this lesion carried out in a young boy originate from Guinea

Cerebral embolism and thrombus in a membranous interventricular septal aneurysm.

This report describes the occurrence of a thrombus in an aneurysm of the membranous interventricular septum with cerebral embolism in a young patient. We would recommend periodic echocardiography checkups in patients with aneurysm of the membranous interventricular septum with or without a small ventricular septal defect. The findings of a mass in the aneurysm, suggestive of thrombus, may justify anticoagulation treatment or even surgical intervention.