Prevention of incisional hernia with a reinforced tension line (RTL) versus primary suture only in midline laparotomies: 3-year follow-up in a randomized clinical trial.

PURPOSE: Incisional hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy. METHODS: Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed. RESULTS: A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14-0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. CONCLUSIONS: The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. TRIAL REGISTRATION: Local Committee CI-HRAEB-2013-020. March 13, 2013. CLINICAL TRIALS: NCT02136628, retrospectively registered.

Topographic synthesis of arbitrary surfaces with vortex Jinc functions.

When a circular aperture is uniformly illuminated, it is possible to observe in the far field an image of a bright circle surrounded by faint rings known as the Airy pattern or Airy disk. This pattern is described by the first-order Bessel function of the first type divided by its argument expressed in circular coordinates. We introduce the higher-order Bessel functions with a vortex azimuthal factor to propose a family of functions to generalize the function defining the Airy pattern. These functions, which we call vortex Jinc functions, happen to form an orthogonal set. We use this property to investigate their usefulness in fitting various surfaces in a circular domain, with applications in precision optical manufacturing, wavefront optics, and visual optics, among others. We compare them with other well-known sets of orthogonal functions, and our findings show that they are suitable for these tasks and can pose an advantage when dealing with surfaces that concentrate a considerable amount of their information near the center of a circular domain, making them suitable applications in visual optics or analysis of aberrations of optical systems, for instance, to analyze the point spread function.

Initial Report on the Results of the Kidney Transplant Program at the Bajio Regional High Specialty Hospital.

BACKGROUND: We present the first results of our program, which is characterized by its acceptance of any candidate with chronic renal failure. Therefore, we serve all patients, regardless of their social security and socioeconomic status. METHODS: We conducted a retrospective, descriptive, cross-sectional study describing the characteristics of patients who received kidney transplants in the period from 2008 to 2015. Descriptive statistics were used to evaluate our findings. RESULTS: A total of 708 transplants were performed, with 377 (53%) involving a living donor and 331 (47%) involving deceased donors. The patients' mean age was 26 years (±12.7 SD), with a range of 5 to 69 years. Of these patients, 488 were male (68.9%), and 423 (59.7%) had no social security. The replacement therapy prior to transplantation was peritoneal dialysis in 40% of cases, hemodialysis in 57% of cases, and 3% of patients had no prior therapy. The blood group distribution was 436 (61%) type O; 177 (25%) type A; 78 (11%) type B; and 8 (1%) type AB. The average hospital stay for a living donor transplant was 9 days and 13 days in the case of a deceased donor. CONCLUSIONS: This study describes the basic clinical and epidemiological characteristics of our transplant population. These results can be used as a basis for future descriptive and prospective studies at our institution or in other inter-agency and national projects. We also highlight the rapid development of the kidney transplant program at the Bajio Regional High Specialty Hospital.

Polymorphous low-grade adenocarcinoma of the parotid gland. Case report and review of the literature.

Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose both clinically and histologically due to its indolent presentation, and because of its morphological diversity that includes several microscopic patterns. The aggressive biologic behavior seen in minor salivary glands as compared to major glands is apparently associated histologically to a predominance of the papillary pattern in the former. Biologic behavior of PLGA in the major salivary glands is uncertain, as some cases have developed recurrences and metastases independently of the presence of a papillary pattern. A case of PLGA originated de novo in parotid gland is presented a 60 year-old male, treatment was surgically excised through superficial parotidectomy and to postoperative radiotherapy (46 Gy). Forty-eight months later the patient is alive with no signs of recurrence, as well as a review of the literature, with particular emphasis in its differential diagnosis and biological behavior.

Polymorphous low-grade adenocarcinoma of the parotid gland. Case report and review of the literature

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Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose both clinically and histologically due to its indolent presentation, and because of its morphological diversity that includes several microscopic patterns. The aggressive biologic behavior seen in minor salivary glands as compared to major glands is apparently associated histologically to a predominance of the papillary pattern in the former. Biologic behavior of PLGA in the major salivary glands is uncertain, as some cases have developed recurrences and metastases independently of the presence of a papillary pattern. A case of PLGA originated de novo in parotid gland is presented a 60 year-old male, treatment was surgically excised through superficial parotidectomy and to postoperative radiotherapy (46 Gy). Forty-eight months later the patient is alive with no signs of recurrence, as well as a review of the literature, with particular emphasis in its differential diagnosis and biological behavior

Reproductive biology of henequen (Agave fourcroydes) and its wild ancestor Agave Angustifolia (Agavaceae). i. Gametophyte development.

The pathways of micro- and megagametophyte development in Agave fourcroydes (henequén) and A. angustifolia were studied. We used histology and light microscopy to observe anther ontogeny and ovary differentiation in relation to flower bud size. Both species have the same sexual reproductive strategies and gametophyte development that may be divided into three phases: (1) premeiotic, which includes the establishment of the megaspore mother cell and the pollen mother cell; (2) meiotic, the formation of mature microspores and functional megaspores; (3) postmeiotic, which encompasses the development of mature pollen grains and the formation of the embryo sac. A successive type microsporogenesis was found in both species with formation of T-shaped tetrads and binuclear pollen grains. In vitro germination tests revealed very low pollen fertility. The female gametophyte is formed from two micropylar megaspore cells after the first meiotic division (bisporic type). Male and female gametogenesis occur asynchronously with microsporogenesis finishing before macrosporogenesis. The results so far show that the formation of male and female gametophytes in henequén is affected at different stages and that these alterations might be responsible for the low fertility shown by this species.

[Abdominal complications after cardiopulmonary procedures]. / Complicaciones abdominales consecutivas a derivación cardiopulmonar.

OBJECTIVE: To know the frequency of intraabdominal complications and its impact on survival of patients submitted to cardiopulmonary bypass for common open-heart surgical procedures. BACKGROUND: The gastrointestinal complications after cardiac surgery with cardiopulmonary bypass (CPB) have an incidence of 0.3 to 3% but mortality can exceed 60%. Despite improvements in preoperative, operative and postoperative care it has been the general impression that abdominal complications remain a significant problem. TYPE OF STUDY: Retrospective case-control study. MATERIAL AND METHODS: Consecutive patients submitted to cardiac surgery with CPB between March 1995 to March 1997 were included. Any gastrointestinal complication was identified as well as its diagnosis, medical or surgical management and mortality. RESULTS: One thousand and three hundred fifty two patients were studied of which 516 (38%) were operated for coronary revascularization, 502 (37%) valvular replacement, 68 (5.2%) a combination of valvular replacement and revascularization, 144 (10.6%) correction of congenital defects and 122 (9.6%) treated of diverse problems. Forty-four patients developed complications (3.3%) and they were, postoperative intestinal ileus in 14 cases (32%), half of them had concomitant hyperamylasemia. Hepatobiliary complications represented 29.5% (13 cases). Ten patients (22.7%) developed peptic ulcer disease complicated with perforation or hemorrhage. Severe acute pancreatitis was observed in two patients as well as two with bowel necrosis. Three patients had complications considered not related to CPB as grade I liver trauma, acute appendicitis and amebic colitis. The mortality was 11/44 (25%). As a control group, 73 patients operated upon over the same time period and on the same days as the study patients were analyzed. The mortality in this group was 5/73 (6.8%). The medical history of peptic ulcer disease (< 0.01) and postoperative hemodynamic unstability (< 0.05), the use of intra-aortic balloon pump (< 0.05) and respiratory failure with prolonged ventilatory support (< 0.05) were separate statistical significant determinants for the development of postoperative abdominal complications. CONCLUSIONS: Factors indicative of or contributing to periods of decreased end-organ perfusion appear to be significantly related to abdominal complications. Also, medical history of peptic ulcer disease represented an individual determinant of severe surgical complications as ulcer perforation and massive bleeding.

[Hartmann's procedure. Institutional experience with 92 consecutive cases]. / Operación de Hartmann. Experiencia institucional de 92 casos consecutivos.

BACKGROUND: Since it's description in 1923, Hartmann's procedure is widely used for the surgical treatment of acute left colonic complications when preoperative bowel lavage is not feasible and/or there is high risk of anastomotic dehiscence. OBJECTIVE: Analyze the results of Hartmann's operation in the surgical treatment of consecutive patients at a single institution during a 30-month interval. TYPE OF STUDY: Prospective, non-randomized and longitudinal study. MATERIAL AND METHODS: Patients treated with the Hartmann procedure between March 1995 and September 1998. Surgical indication, intraoperative findings, morbidity and mortality were analyzed as well as the rate of reestablishment of bowel continuity and it's morbimortality. RESULTS: Ninety-two patients underwent a Hartmann procedure. The mean patient's age was 60 +/- 25 years (range of 21 to 88 years) and 60% were older than 65 years. An emergency operation was carried out in 91% of the cases. Most of the patients had intra-abdominal sepsis (56%) and benign colonic process (83%). The morbidity rate was 34% and mortality rate 19. During follow-up the bowel continuity was reestablished in 32% of the cases without fatalities. CONCLUSIONS: Hartmann's procedure is a good option for non-elective surgical treatment complicated rectosigmoid pathology. The morbidity and mortality of the operation are highly dependent on the degree of preoperative sepsis and the patient's preexisting condition. The rate of reestablishment of bowel continuity was low probably because of short follow-up.

A highly sensitive method for diagnosis of secondary amyloidosis by labial salivary gland biopsy.

Both labial salivary gland and gingival biopsies were taken from 19 patients with clinical findings suggestive of secondary amyloidosis. Amyloid deposits were present in all salivary gland biopsies (19/19) while amyloid deposits in gingiva were observed only in three cases (16%). No amyloid was found in similar biopsies from 11 control patients. Periductal amyloid involvement was found along the basement membrane in all salivary gland samples; additionally, 16 cases had periacinar infiltration (84%), 13 had perivascular (68%) and 7 (37%) showed interstitial deposits. Amyloid in gingiva was seen along the epithelial basement membrane, as in salivary glands, although in isolated areas and scattered at the top of some dermal papillae and small blood vessels. In secondary amyloidosis it therefore appears that amyloid is deposited along the epithelial basement membrane before perivascular deposition occurs. This study presents a new highly sensitive and reliable method for the diagnosis of secondary amyloidosis, a method which is technically simple, free from complications and well-accepted by the patients.