Disparidad global por sexo de Covid-19: una revisión descriptiva de las hormonas sexuales y consideración del uso terapéutico potencial de la terapia de reemplazo hormonal en adultos mayores / COVID-19 global gender disparity: a descriptive review of sex hormones and consideration of the potential therapeutic use of hormone replacement therapy in older adults

La pandemia de coronavirus-2 (SARS-CoV-2) relacionada con el SARS 2019-2020 ha traído desafíos sin precedentes a los sectores de la salud en todo el mundo. Hasta noviembre de 2020, ha habido más de 64 millones de casos confirmados y se acercan a 2 millones de muertes en todo el mundo. A pesar de la gran cantidad de casos positivos, existen muy pocos estándares establecidos de atención y opciones terapéuticas disponibles. Hasta la fecha, (Diciembre 2020) todavía no existe una vacuna aprobada por la Administración de Alimentos y Medicamentos (FDA) para COVID-19, aunque existen varias ensayos clínicos en diferentes. etapas de desarrollo. En este documento, hemos realizado una revisión global que evalúa los roles de la edad y el sexo en las hospitalizaciones por COVID-19, las admisiones a la UCI, las muertes en hospitales y las muertes en hogares de ancianos. Hemos identificado una tendencia en la que las personas mayores y los pacientes masculinos se ven afectados significativamente por los resultados adversos.

The original Ivor Lewis two stage esophagectomy revisited in the era of minimally invasive surgery.

BACKGROUND: Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach. METHODS: Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease. RESULTS: Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108 ±â€¯18 and 226 ±â€¯63 min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication. CONCLUSION: Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications.

False left ventricular aneurysm with ventriculo-bronchial fistula and massive haemoptysis.

An intravenous drug user presented with bacteraemia and massive hemoptysis 10 years after a penetrating cardiac injury. He was found to have false left ventricular aneurysm with ventriculo-bronchial fistula. The clinical course suggests that the aneurysm became infected and that the inflammatory process weakened the aneurysmal sac and led to the development of fistula. Prompt recognition of the aneurysm with appropriate surgical repair resulted in a successful outcome.

Examination of three-dimensional movements in human embryos using computer imaging technology.

This paper describes the use of computer imaging technology to study in three dimensions the dynamics of differentiations in human embryos. Three-dimensional computer reconstruction technology was used to build a series of models of the brain/face and the ear region from fixed, serially sectioned embryos at representative stages. When certain principles are followed each model can be equated to one frame on a motion picture film. The dynamics of differentiation are then revealed as changes in size, shape and position (growth movements) of multiple structures as they build the definitive arrangement.

Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?

Mediastinitis and/or sternal dehiscence developed in 143 out of 10,263 patients (1.4%) who underwent cardiac surgery between January 1979-December 1993. Mediastinal drainage, sternal debridement and early wound closure with pectoralis major and/or rectus abdominalis muscle flaps was the treatment employed. Between these two stages of treatment, massive hemorrhage developed in seven patients (0.07%) from a tear of the anterior wall of the right ventricle (RV). Six patients survived. Temporary control of the bleeding was achieved with digital or full palm pressure control of the ventricular tear. This was followed by immediate repair in the operating room (OR). The only death was due to exsanguination in the intensive care unit. The other six patients were taken to the OR. The anterior RV was freed from the underside of the sternum and the RV tear repaired with or without the aid of femoral-femoral bypass. These six then had muscle flap wound closures at that time or shortly after. All six were hospital survivors and are currently alive. We believe that RV rupture results from the sternal edges pulling the anterior surface of the RV apart, since the RV is stuck to the underside of the sternum. This experience indicates that the RV must be freed in all cases during initial sternal debridement. Hopefully this simple maneuver will prevent this horrendous complication.

Massive esophageal bleeding in achalasia complicated by cytomegalovirus esophagitis.

A 69-year-old man with achalasia who had received cytoxan and prednisone over a 6-week period for presumed Wegener's granulomatosis presented with massive esophageal bleeding. He did not respond to aggressive medical management, and an emergent esophagectomy was performed. Histologic examination revealed extensive cytomegalovirus esophagitis. He had a long but progressive hospital course and was discharged 1 month after admission. This case illustrates that cytomegalovirus esophagitis may cause massive hemorrhage that necessitates surgical intervention.