Clinical and demographic factors associated with the effectiveness of temporomandibular joint arthroscopy.

PURPOSE: High success rates and minimal complications have consolidated arthroscopy as the therapeutic alternative of choice for minimally invasive treatment of internal disorders (ID) of the temporomandibular joint (TMJ). However, there is no certainty regarding the demographic and clinical factors associated with the technique's success or failure. This study was performed to analyze the effectiveness of arthroscopy regarding pain and the mandibular dynamics and also to determine whether variables such as age, sex, and preoperative Wilkes stage influence the results. METHODS: A retrospective study was conducted involving 92 patients with ID of the TMJ between September 2017 and February 2020. In all cases, a first stage of intra-articular lysis and lavage was executed. As needed, a phase of operative arthroscopy or arthroscopic discopexy was implemented. RESULTS: A total of 152 arthroscopies were performed. Both the variation in pain and mouth opening in patients with ID of the TMJ treated were statistically significant for the follow-up periods studied. Better results were observed for patients with lower Wilkes stages. No association with age was found. CONCLUSION: Based on the results, we recommend early intervention as soon as an ID in the TMJ is detected.

Postharvest Treatment of Hydrogen Sulfide Delays the Softening of Chilean Strawberry Fruit by Downregulating the Expression of Key Genes Involved in Pectin Catabolism.

Hydrogen sulfide (H2S) plays several physiological roles in plants. Despite the evidence, the role of H2S on cell wall disassembly and its implications on fleshy fruit firmness remains unknown. In this work, the effect of H2S treatment on the shelf-life, cell wall polymers and cell wall modifying-related gene expression of Chilean strawberry (Fragaria chiloensis) fruit was tested during postharvest storage. The treatment with H2S prolonged the shelf-life of fruit by an effect of optimal dose. Fruit treated with 0.2 mM H2S maintained significantly higher fruit firmness than non-treated fruit, reducing its decay and tripling its shelf-life. Additionally, H2S treatment delays pectin degradation throughout the storage period and significantly downregulated the expression of genes encoding for pectinases, such as polygalacturonase, pectate lyase, and expansin. This evidence suggests that H2S as a gasotransmitter prolongs the post-harvest shelf-life of the fruit and prevents its fast softening rate by a downregulation of the expression of key pectinase genes, which leads to a decreased pectin degradation.

Uso de fluoroscopia intraoperatoria en el tratamiento de fracturas aisladas de arco cigomático. Ensayo clínico aleatorizado / Use of intraoperative fluoroscope in the treatment of isolated zygomatic arch fractures: a randomized clinical trial

Objetivo. La reducción de la fractura aislada de arco cigomático (FAAC) es, habitualmente, realizada a distancia mediante un abordaje temporal de Gillies. No se recomienda una reducción abierta por la gran morbilidad y complicaciones asociadas. Sin embargo, al realizar una reducción cerrada, es muy difícil precisar si fue satisfactoriamente realizada. El objetivo de este trabajo es determinar si la adquisición de imágenes intraoperatorias con un arco en C para evaluar la reducción de FAAC es una técnica útil en el tratamiento de dichas fracturas. Métodos. Nuestra hipótesis es que utilizar un arco en C para adquirir imágenes intraoperatorias reduce la necesidad de una segunda cirugía. Entre los años 2009 y 2012, 50 pacientes que fueron diagnosticados con FAAC y que requerían tratamiento quirúrgico fueron distribuidos aleatorizadamente en 2 grupos: 25 pacientes en un grupo experimental en que se realizaba reducción de la fractura y corroboración inmediata de un adecuado resultado con arco en C intraoperatoriamente y 25 pacientes en un grupo control en que se realizaba reducción de la fractura con imagen de control posterior a la cirugía. Resultados. Los resultados mostraron que no hubo diferencias significativas entre ambos grupos (p=0,05). Sin embargo, existió la ventaja de poder reducir de nuevo la fractura inmediatamente si el resultado no era satisfactorio en el grupo experimental. Conclusión. A pesar de que los resultados no son estadísticamente significativos, los autores recomiendan realizar imágenes intraoperatorias en aquellas zonas de las que no se tiene certeza de la reducción (AU)

Purpose. Isolated zygomatic arch fractures (IZAF) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. Methods. Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009-2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into 2 groups: 25 patients in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm; 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. Results. The results did not reveal significant differences between both groups (P=.05). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. Conclusions. Despite the fact that the results are not statistically significant, the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction (AU)

Acceso retrocaruncular para la reconstrucción de la pared medial de la órbita / Retrocaruncular approach to orbital medial wall reconstruction

Objetivo. Realizar un análisis retrospectivo de la utilización del acceso retrocaruncular para abordar las reconstrucciones orbitarias de la pared medial. Adicionalmente, la técnica para realizar este acceso es descrita. Material y método. La muestra fue seleccionada de la población derivada al Servicio de Cirugía Maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C (Santiago, Chile) para el tratamiento de fracturas orbitarias producto de traumatismo entre el 1 de enero del 2011 y el 31 de diciembre del 2014. Criterios de inclusión: mayores de 18 años con fracturas aisladas de pared medial de órbita o combinadas con piso orbitario, uni o bilaterales, con indicación quirúrgica, abordadas mediante acceso retrocaruncular y con un seguimiento mínimo de 6 meses. Criterios de exclusión: fractura de techo y/o pared lateral de la órbita. Resultados. Ciento sesenta y ocho órbitas fueron operadas durante el periodo indicado; 27 órbitas con fracturas de pared medial abordadas mediante acceso retrocaruncular con extensión transconjuntival y cantotomía lateral fueron incluidas en este estudio; 6 de ellas eran fracturas de pared medial puras y las 21 restantes combinadas con piso. Exceptuando un caso que requirió reconstrucción tardía con implante de titanio customizado, todas las reconstrucciones de órbita fueron exitosas en la primera cirugía. Salvo un paciente que desarrolló un granuloma conjuntival en relación con la carúncula, ningún paciente tuvo complicaciones en relación con el acceso retrocaruncular. Conclusiones. La técnica para el acceso retrocaruncular presentada otorga un seguro, amplio y directo acceso a la pared medial para realizar reconstrucción de la órbita, obteniendo óptimos resultados estéticos y funcionales con mínimas complicaciones (AU)

Objective. To present a retrospective analysis of the use of retrocaruncular approach to access medial orbital wall reconstruction. Additionally, the technique for performing this access is described. Material and method. The sample for this study was chosen from the population of patients referred to the Maxillofacial Surgery Service at the Hospital Clínico Mutual de Seguridad C.Ch.C (Santiago, Chile) for the treatment of orbital fractures between 1st of January 2011 and 31st of December 2014. Subjects eligible for study inclusion had age ≥18, either isolated medial orbital wall fractures or combined with floor fractures, uni or bilateral, with surgical indication, accessed with retrocaruncular approach and 6 month of follow up at least. Exclusion criteria: roof and/or lateral orbital wall fractures. Results. Between January 2011 and December 2014, a total of 168 orbits were treat. 27 orbits with medial wall fractures were accessed with retrocaruncular approach with transconjunctival extension and lateral canthotomy and were included in this study. Of them, 6 were pure medial wall fractures and 21 combined with floor fractures. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Except for a patient who developed a conjunctival granuloma in relation to the caruncle, no patients had complications related to retrocaruncular access. Conclusiones. The retrocaruncular approach presented allows asafe, wide and direct access for repairing medial orbital wall fractures with optimal aesthetics results and minimal functional complication (AU)

The Imaging Appearance of Sinus Mycetoma: A Case Series / El Aspecto Imagenológico del Micetoma Sinusal: Serie de Casos

Sinus mycetoma is a dense accumulation of hyphae that form a rounded mass within the mucosal confines of a paranasal sinus. The aim of this study was to present a case series of three patients with maxillary sinus mycetoma and to describe their radiographic presentations. Three cases are presented. The first two, a 44-year-old woman and an 88 year-old man, both diabetics, were referred to maxillofacial treatment by other specialties. They both had a bad odor of unknown origin on the facial level and their respective computerized tomographies revealed a unilateral opacification of the maxillary sinus with a region of greater radio-opacity. The third case is a 31-year-old woman with a history of a severe facial trauma who had undergone surgery and for whom orthognathic surgery had been planned to correct side effects. In addition to the orthognathic surgery, the removal of the lesion that appeared opacified in the pre-surgery scan was planned. She showed opacification of the maxillary sinus and during the intraoperative stage, tissue of a whitish-gray appearance was detected on the maxillary sinus. The lesion was completely removed and the result of the histopathological study was sinus mycetoma. The patients evolved favorably and the symptomatology disappeared completely. The growing occurrence of mycetoma and the lack of information on it make publicizing this pathology fundamental so it can be considered as a differential imaging, clinical, and pathological diagnosis and in that way receive adequate and opportune treatment.

El micetoma sinusal es una patología de origen fúngico, que afecta a pacientes inmunocomprometidos, capaz de desorientar en su diagnóstico por su clínica y expresión imagenológica particular. El objetivo de este estudio es presentar una serie de tres casos con micetoma en el seno maxilar y describir su presentación imagenológica. Se presentan tres casos. Los dos primeros, una mujer de 44 años y un hombre de 88 años, ambos diabéticos y derivados a atención maxilofacial por otras especialidades. Coincidía un mal olor expelido de origen desconocido a nivel facial y en sus respectivas tomografías computarizadas se observó velamiento unilateral del seno maxilar con una zona de mayor hiperdensidad. El tercer caso corresponde a una mujer de 31 años con antecedente de trauma facial severo operado, a la cual se le planificó cirugía ortognática para corregir secuelas. En conjunto con la cirugía ortognática, se planificó la biopsia excisional de una lesión hiperdensa que se presentó en el escáner pre-quirúrgico; en el intraoperatorio se pesquisó tejido de aspecto blanquecino grisáceo en el seno maxilar. A todos los pacientes se les realizó la exéresis total de la lesión y el estudio histopatológico dio como resultado micetoma sinusal. Los pacientes evolucionaron favorablemente, desapareciendo por completo la sintomatología. La creciente incidencia del micetoma y el desconocimiento sobre el mismo hacen que sea fundamental la difusión de esta patología para ser considerada como diagnóstico diferencial clínico y patológico, y realizar así un tratamiento adecuado y oportuno.

C-arm as intraoperative control in reduction of isolated zygomatic arch fractures: a randomized clinical trial.

PURPOSE: Isolated zygomatic arch fractures (IZAFs) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. METHODS: Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009 and 2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into two groups: 25 patients were in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm, and 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. RESULTS: The results did not reveal significant differences between both groups (p = 0.5). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. CONCLUSIONS: Despite the fact that the results are not statistically significant (p = 0.5), the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.

Hematocele secondary to rupture of an abdominoscrotal hydrocele.

OBJECTIVE: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient. METHODS AND RESULTS: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space. CONCLUSIONS: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment.

Hematocele gigante secundario a la ruptura de un hidrocele abdomino-escrotal / Hematocele secundary to rupture of an abdominoscrotal hydrocele

OBJETIVO: Presentación de un caso de hematocele secundario a un hidrocele abdomino escrotal en la edad adulta. MÉTODO Y RESULTADO: Presentamos el caso de un paciente que presentó este inusual tipo de hidrocele que tras un mínimo traumatismo escrotal ocasionó un importante hematocele. Se trata de un hidrocele que se extiende a través del canal inguinal hacia el espacio retroperitoneal, reseñando su aproximación diagnóstica así como el tratamiento quirúrgico. CONCLUSIONES: El hidrocele abdomino escrotal es una patología infrecuente en niños y lo es aún más en adultos. La presencia de un hematocele exige un tratamiento quirúrgico precoz (AU)

OBJECTIVE: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient. METHODS AND RESULTS: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space. CONCLUSIONS: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment (AU)

Litiasis múltiples en neovejiga tipo Hautmann / Multiple lithiasis in Hautmann neobladder

No disponible

Cuerpo extraño intraureteral / Intraurethral foreign body

No disponible

Percutaneous tibial nerve stimulation in treatment of overactive bladder: when should retreatment be started?

OBJECTIVE: To study the response to posterior tibial nerve stimulation in patients with overactive bladder refractory to medical treatment. METHODS: A cohort of 53 patients were treated by posterior tibial nerve stimulation and followed up for a maximum of 24 months. All patients completed the International Consultation on Incontinence Modular Questionnaire-Short Form quality of life questionnaire and kept a urination diary to record the daytime urination frequency and night-time urination frequency. Urodynamic studies were also conducted. RESULTS: At 6 months of follow-up, a cure/improvement rate of 92.4% (49 of 53 cases) had been achieved. Ten patients were given additional treatment and were excluded from subsequent follow-up analysis. At 12 months of follow-up, a cure/improvement rate of 91.69% had been achieved (39 of 43). At 24 months of follow-up, of the 16 patients initially included during the first year, a cure/improvement rate of 62.5% had been achieved (10 of 16). The first sensation of bladder filling had increased by the end of treatment, with differences observed before and after posterior tibial nerve stimulation (P ≤ .001). The average post-treatment bladder capacity had increased by 72.7 mL compared with the initial value (P ≤ .001). At 24 months of follow-up, the group of 16 patients evaluated recorded a significant worsening of night-time urination frequency (P ≤ .05) and quality of life (P ≤ .01). CONCLUSION: Posterior tibial nerve stimulation is a good option for the treatment of overactive bladder. In our series, the optimal point to start retreatment would be at 24 months after therapy completion.

Barbagli's dorsal urethroplasty. Analysis of results and factors for success.

OBJECTIVES: Dorsal urethroplasty as described by Barbagli has gained wide acceptance in the treatment of urethral stricture, given the simplification afforded by obtaining a free graft versus a flap. We present a series of 50 patients treated in our department of urethral stricture by dorsal onlay free graft urethroplasty (Barbagli's technique), in combination or not to other techniques in more complex strictures. METHODS: The average age of patients was 48.8 years (23-77), the mean follow up 42.9 months (12-96) and the most frequently observed etiology has been the inflammatory urethral stricture (50%). RESULTS: Overall success rate was 82% (41 cases) and failure 18% (9 cases). In the longer follow-up group, there was a slight drop in success rate of 80% (24 cases) without any significant differences between groups (p= 0.9). Analyzing the variables length of free graft (p= 0.50, p> 36= 0.53), age (p= 0.12, p>36= 0.59), etiology of stricture (p= 0.77, p>36 = 0.77) and type of graft used (p=0.24, p>36= 0.38) did not show any influence on the final outcome of surgery, both in the total sample and the subgroup with follow-up > 36 months. The location of the stricture in bulbar urethra has shown better functional outcome than those operated on for strictures affecting also other urethral locations (p= 0.001) maintaining that result in the group of longer follow up (p>36= 0,001). The lack of treatment prior to urethral surgery has influenced the success of it, since 90.6% of patients without prior treatment before urethroplasty have seen a good functional outcome, compared to treatment prior to surgery that obtained a 66.7% (p= 0.03). This significance is also demonstrated in the group of follow-up > 36 months (p>36= 0.01). CONCLUSION: The dorsal onlay free graft urethroplasty is a versatile and reproducible technique with acceptable results which allows combination with other techniques when the stenosis extends to the penile urethra. In exceptional cases of panurethral strictures secondary to lichen sclerosus when there is no significant spongiofibrosis and an acceptable urethral plate, can be applied to the whole urethra.

Uretroplastia dorsal según técnica de Barbagli. Análisis de resultados y factores de éxito / Barbagli`s dorsal urethroplasty. Analysis of results and factors for success

OBJETIVO: La uretroplastia dorsal descrita por Barbagli ha ganado amplia aceptación en el tratamiento de la estenosis de uretra, dada la simplificación que otorga la obtención del injerto libre frente a los pediculados.Presentamos una serie de 50 casos intervenidos en nuestro servicio de estenosis de uretra mediante uretroplastia dorsal con injerto libre (técnica de Barbagli), asociado o no a otras tecnicas en estenosis mas complejas.MÉTODOS: La edad media de los pacientes ha sido de 48.8 años (23-77), el tiempo de seguimiento medio de 42.9 meses (12-96) y la etiología más observada ha sido la estenosis uretral inflamatoria (50%).RESULTADOS: La tasa global de éxito ha sido del 82% (41 casos) y la de fracaso 18% (9 casos). En el grupo de mayor seguimiento, se observa un leve descenso de la tasa de éxito del 80% (24 casos) sin que se aprecien diferencias entre ambos grupos (p=0.98).El análisis de las variables longitud del injerto (p=0.50; p>36=0.53), edad (p= 0.12; p>36=0.59), etiología de la estenosis (p=0.77; p>36=0.77) y tipo de injerto utilizado (p=0.24; p>36=0.38), no demostraron ejercer influencia alguna en el resultado final de la cirugía, tanto en el total de la muestra como en el subgrupo de seguimiento >36 meses.La localización de la estenosis en uretra bulbar ha demostrado mejor resultado funcional que los intervenidos por estenosis que afectaban además a otras zonas de la uretra (p= 0.001) manteniéndose dicho resultado en el grupo de mayor seguimiento (p>36=0.001).La ausencia de tratamiento previo a la cirugía uretral ha influenciado el éxito de la misma, ya que el 90.6% de pacientes sin tratamiento anterior a la uretroplastia han observado un buen resultado funcional frente al grupo de tratamiento previo a cirugía que lo ha obtenido en un 66.7% (p=0.03). Esta significación también se demuestra en el grupo de 36 meses (p>36 = 0.01)(AU)

CONCLUSIÓN: La uretroplastia dorsal con injerto libre es una técnica versátil y reproducible con unos resultados aceptables que permite su asociación a otras técnicas cuando la estenosis se extiende a la uretra peneana(AU)

OBJECTIVES: Dorsal urethroplasty as described by Barbagli has gained wide acceptance in the treatment of urethral stricture, given the simplification afforded by obtaining a free graft versus a flap.We present a series of 50 patients treated in our de-partment of urethral stricture by dorsal onlay free graft urethroplasty (Barbagli’s technique), in combination or not to other techniques in more complex strictures.METHODS: The average age of patients was 48.8 years (23-77), the mean follow up 42.9 months (12-96) and the most frequently observed etiology has been the inflammatory urethral stricture (50%).RESULTS: Overall success rate was 82% (41 cases) and failure 18% (9 cases). In the longer follow-up group, there was a slight drop in success rate of 80% (24 ca-ses) without any significant differences between groups (p= 0.98).Analyzing the variables length of free graft (p= 0.50, p> 36= 0.53), age (p= 0.12, p>36= 0.59), etiology of stricture (p= 0.77, p>36 = 0.77) and type of graft used (p=0.24, p>36= 0.38) did not show any influence on the final outcome of surgery, both in the total sample and the subgroup with follow-up > 36 months.The location of the stricture in bulbar urethra has shown better functional outcome than those operated on for stric-tures affecting also other urethral locations (p= 0.001) maintaining that result in the group of longer follow up (p>36= 0,001).The lack of treatment prior to urethral surgery has influen-ced the success of it, since 90.6% of patients without prior treatment before urethroplasty have seen a good func-tional outcome, compared to treatment prior to surgery that obtained a 66.7% (p= 0.03). This significance is also demonstrated in the group of follow-up > 36 months (p>36= 0.01)(AU)

CONCLUSION: The dorsal onlay free graft urethroplas-ty is a versatile and reproducible technique with accep-table results which allows combination with other tech-niques when the stenosis extends to the penile urethra. In exceptional cases of panurethral strictures secondary to lichen sclerosus when there is no significant spongiofi-brosis and an acceptable urethral plate, can be applied to the whole urethra(AU)