Ludwig's angina complicated with a massive necrotizing fasciitis caused by an unusual pathogen: Bacillius spp

Ludwig's angina and necrotizing fasciitis are aggressive infectious manifestations that can present in the cervicofacial region. The severity of these entities depends, up to some extent, to the immunological state of the patient. Diabetes mellitus alters the immune system, allowing maxillofacial infections to progress aggressively. Bacillius spp. is a group of typically innocuous bacteria; however, they can unchain relevant infectious pathologies in immunocompromised patients. The purpose of this study is to describe a case of an uncontrolled diabetic patient with a Ludwig's angina which progressed to a massive necrotizing fasciitis caused by bacillius spp. Explaining the severity of this class of infections and the special attention that should be paid to this type of case; Furthermore, when the culture reveals pathogens that are usually not involved in the development of this class of conditions.

Eritema multiforme como manifestación paraneoplásica de un adenocarcinoma de colon

RESUMEN: El eritema multiforme es una enfermedad autoinmune vesicular-ampollosa y autolimitada, se presenta de forma aguda afectando la piel y mucosa. En 2015, Lee E. y Freer J., incluyeron esta enfermedad dentro de los síndromes dermatológicos paraneoplásicos, pero actualmente no existen muchas publicaciones de esta entidad como manifestación a una neoplasia subyacente. El objetivo de esta investigación es presentar el eritema multiforme como una manifestación paraneoplásica inusual. En este caso una paciente de 64 años de edad que cursaba con adenocarcinoma de colon exhibió el eritema multiforme oral; cuyas manifestaciones bucales involucionaron gracias a la farmacoterapia local y sistémica en conjunto con la excéresis de la lesión cancerosa en el colon. Es importante reconocer la presencia de eritema multiforme como una manifestación paraneoplásica cuando no se exhiben los factores etiológicos frecuentes de esta patología y, por lo tanto, centrarse en la búsqueda subyacente de neoplasias malignas que no son muy evidentes.

ABSTRACT: Erythema multiforme is a self-limiting, blistering, autoimmune disease that presents acutely, affecting the skin and mucosa. In 2015, Lee E. and Freer J. included this disease in paraneoplastic dermatological syndromes, but there are currently not many publications about this entity as a manifestation of an underlying malignancy. The objective of this research is to present the erythema multiforme as an unusual paraneoplastic manifestation. In this case, a female 64-year-old patient with colon adenocarcinoma exhibited oral multiform erythema; whose oral manifestations regressed thanks to local and systemic pharmacotherapy in conjunction with the exeresis of the cancerous lesion in the colon. It is important to recognize the presence of erythema multiforme as a paraneoplastic manifestation when the frequent etiological factors of this pathology are not exhibited and, therefore, to focus on the underlying search for malignant neoplasms that are not very evident.

Submalar fat pad removal for esthetic purposes: A systematic approach.

OBJECTIVE: Submalar fat pad removal for esthetic purposes has been performed as a routine in the last decades. However, several factors have not been properly analyzed and studied. In order to address this problem, the purpose of this study is to describe clinical parameters to be taken into account when analyzing potential patients as well as a systematic approach during the pre, intra and postoperative stages. MATERIALS AND METHODS: Patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients underwent the same patient selection criteria and pre, intra and post-surgical protocol. RESULTS: A total of 44 patients were selected. 40 females and 4 males, with a mean age of 25.4 years. The bilaterally excised buccal fat pads had an average weight of 4.3 gs. There was only 1 complication (unilateral emphysema), during the immediate postoperative phase. CONCLUSIONS: Submalar fat pad removal is an effective technique for refining the facial silhouette that should be reserved only for patients with increased buccal fat pad volume or its pseudoherniation. Performing the surgery following the protocol established in our study can allow the surgeon to achieve more reliable intra and postoperative outcomes.

Gallbladder cancer who is really cured?

BACKGROUND: Although gallbladder cancer (GBCA) is characterized by a dismal prognosis, there is a proportion of patients who are cured. The aim of this study was to analyze the profile of these patients. METHODS: A database was queried for patients who underwent curative resection with a follow-up of at least 5 years. Patients were prospectively treated and registered by the same surgical team. A multivariate regression analysis was used to identify factors associated with long-term survival. RESULTS: From 1988 to 2013, 461 patients were evaluated and 112 who underwent resection were analyzed. Among the patients, five year survival was 57% while lymph node and liver compromise were the only independent factors associated with survival. On the other hand, the elapsed time between the cholecystectomy and the resection, the differentiation grade and the level of wall invasion did not have an independent effect on the prognosis. CONCLUSION: Despite its poor prognosis, a subset of patients can be cured of GBCA. R0 resection of patients without lymph and liver infiltration are key to GBCA survival.

Uso de los gases arteriales en trauma / Blood gas use in trauma

El trauma continúa siendo una de las primeras causas de muertes prevenibles en nuestro país. A pesar de la disminución del trauma militar, la incidencia que abarca todas las formas de trauma continúa siendo alta y congestiona los servicios de urgencias, por eso es fundamental el adecuado enfoque inicial para disminuir la mortalidad. Tradicionalmente, se han utilizado marcadores, como los signos vitales, para la identificación del choque hemorrágico, pero estudios observacionales de gran escala han demostrado cómo estos muchas veces no logran identificar a los pacientes con choque hemorrágico, haciendo necesario usar marcadores más objetivos, como los gases arteriales, con la medición del lactato y el déficit de base, que según literatura tienen mejor predicción de mortalidad, identificación temprana del choque y activación temprana de protocolos transfusionales

Trauma continues to be one of the lead causes of preventable deaths in our country. Even with the decrease of military trauma, the incidence of trauma remains high, dominating the emergency room. The initial approach is fundamental to decrease mortality. Traditionally, vital signs have been used as a marker of hemorrhage shock, but observational studies of high volumes of patients showed how those often can't identify patients with hemorrhage shock, which makes necessary more objective markers such as the blood gas with the measure of lactate and base deficit, which has proven useful in the prediction of mortality, early identification of shock and a faster activation of transfusion protocols

Abordaje mínimamente invasivo para el drenaje de infecciones cervicofaciales profundas. Estudio retrospectivo / Minimally invasive approach to drainage of deep cervicofacial infections. Retrospective study

OBJETIVOS: La mayoría de las infecciones cervicales profundas son polimicrobianas y de origen dental, y es necesario un tratamiento apropiado y oportuno. El propósito de esta investigación es describir la eficacia de las incisiones mínimamente invasivas para el drenaje de infecciones cervicales profundas. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo y longitudinal en pacientes con infecciones cervicales profundas, que requirieron ingreso hospitalario, tratados quirúrgicamente con múltiples incisiones mínimamente invasivas. Los datos recopilados incluyeron epidemiología, etiología, órganos dentales y espacio cervicofacial involucrado, tamaño de los abscesos, cantidad de material obtenido, tiempo de hospitalización, tiempo de evolución antes del drenaje, técnica anestésica, método de intubación, método quirúrgico y complicaciones. RESULTADOS: Fueron incluidos un total de 88 pacientes, con un promedio de edad de 39 +/- 14,05 años y una mayor prevalencia del género femenino. El factor etiológico principal fueron los focos sépticos dentales. El espacio más afectado fue el submandibular, en un 39,2 %. El tiempo de evolución antes del drenaje varió entre 1 y 8 días. El promedio del tamaño de los abscesos fue de 6,47 +/- 2,34, 4,03 +/- 1,64, 3,71 +/- 1,59 cm. Un 88,6 % de los pacientes fueron intervenidos bajo anestesia local y un 11,8 % bajo anestesia general. El promedio de la cantidad de material obtenido fue de 104,41 +/- 9 cc. El tiempo promedio de hospitalización fue de 9,43 +/- 3,89 días. No hubo complicaciones locales ni sistémicas. CONCLUSIONES: Las incisiones mínimamente invasivas constituyen una alternativa eficaz, segura y con escasas morbilidades para el drenaje de infecciones cervicales profundas

AIM: Most of deep cervical infections are polymicrobial and come from a dental origin, and an appropriate treatment is necessary. The present paper aims to describe the efficiency of minimally invasive incisions for the drainage of deep cervical infections. MATERIALS AND METHODS: A descriptive, retrospective and longitudinal study in patients with deep cervical infections, who required hospital admission. Patients were surgically treated with multiple minimally invasive incisions. Collected data included: epidemiology, etiology, teeth and cevicofacial spaces involved, size of drained abscesses, amount of material obtained, time of total patient admission, time of evolution before drainage anaesthetic technique, intubation method, surgical method and complications. RESULTS: A total of 88 patients were included in this study, with an average age of 39 +/- 14.05 years and a higher prevalence in women. Teeth infections were the etiological factor in 100 % of the sample. The most affected space was the submandibular with a 39.2 %. The evolution time before drainage varied between 1-8 days. The mean abscess size was 6.47 +/- 2.34, 4.03 +/- 1.64, 3.71 +/- 1.59 cm. In terms of anaesthetic techniques, 88.6% patients were treated under local anesthesia and 11.3 % patients were treated under general anesthesia. The average of the amount of material obtained was 104.41 +/- 9 cc. The average hospitalization time was 9.43 +/- 3.89 days. There were no systemic or local complications. CONCLUSIONS: Minimally invasive incisions represent an effective and safe alternative, with low morbidity, for the drainage of deep cervical infections

Hypertelorism Secondary to Mucocele in the Paranasal Sinuses.

Ocular hypertelorism was introduced by Greig as an increased interpupillary distance. The paranasal sinus mucoceles are acquired lesions for various reasons; however, their behavior is progressive, capable of eroding the bone and extending to the orbital and intracranial regions. The objective is to present a clinical case of orbital hypertelorism secondary to mucocele in the paranasal sinuses. This is a 72-year-old male patient who came presenting an increase in volume in the right nasoorbitoethmoidal region. The isodense lesion occupying the maxillary and right ethmoidal sinuses was confirmed by an intimate relationship with the ipsilateral frontal and sphenoidal sinus, with osteolytic involvement of the orbit and nasal region. After incisional biopsy with mucocele results, a wide resection plus facial reconstruction was performed with autologous grafts and osteosynthesis material. Currently, the patient has 1 year of evolution, without significant functional commitment. It is important to consider giant mucoceles as part of the differential diagnoses in patients with deformities in the middle and upper third of the face.

Laparoscopic management of incidental gallbladder cancer.

BACKGROUND: The laparoscopic cholecystectomy has allowed the detection of an increasing number of incidental gallbladder cancers (IGBC). Although laparoscopy is employed in the management of a variety of abdominal tumors, its use in gallbladder cancer is reduced and controversial. This study analyzes the role of laparoscopy in gallbladder cancer with the focus in IGBC. METHOD: We evaluated our prospective series of 51 patients with an IGBC who were treated by laparoscopy between 2006 and 2016 at the Clinica Alemana in Santiago, Chile. RESULTS: The series comprised 7 men and 44 women. Age ranged from 43 to 76 years (mean age 60). Regarding wall involvement, 29 patients had a T2 tumor, which was the most common. 8 and 14 patients had T1b and T3 tumors, respectively. Of the patients, 17 underwent only laparoscopic exploration. This was due to the presence tumor dissemination not being observed in the preoperative staging. 10 patients had to be converted to complete the resection, whereas 24 patients were laparoscopically resected. The quality of the resected material was not different between those who were converted and those who were treated by laparoscopy. In the laparoscopic group, the average number of harvested lymph nodes was 7.9, not statistically different from the converted group. The mean of hospital stay in the laparoscopic group (4.3 days) was significantly lower than the converted group. CONCLUSIONS: Laparoscopy has been shown to be a safe and feasible method for the management of IGBC. This method not only allows for a complete exploration, identifying a previously unseen residual tumor, but also makes it possible to accomplish the same oncology objectives as the open procedure. Therefore, laparoscopy should be considered a valid alternative in the management of IGBC.

Mandibular Symphyseal L-Inverted Midline Osteotomy to Correct Mild Laterognathia and Malocclusion.

OBJECTIVE: The aim of this study was to present the authors' experience with a new surgical technique to correct mild laterognathia and malocclusion by means of an L-inverted midline osteotomy. PATIENT AND METHODS: The patient was a 26-year-old woman diagnosed with left laterognathia and ipsilateral posterior crossbite. She was operated by using this novel technique in November 2009 at Hogar Clínica San Rafael, Maracaibo, Venezuela. Bicortical midline symphyseal vertical osteotomy was executed, followed by block removal of the central right inferior incisor and its surrounding alveolar bone. The mandibular segmentation was completed by means of a right hemimentoplasty. After this, a 4-mm right mandibular rotation was made, and titanium plates and monocortical screws of the 2.0 system were used to achieve the rigid fixation. RESULTS: The patient showed outstanding aesthetic and functional results after 5 years. CONCLUSIONS: This technique provides a new treatment option for the correction of mild laterognathia cases associated with dental malocclusion.

Colgajo de lengua como alternativa quirúrgica para el cierre de fístulas palatinas / Tongue flap as a surgical alternative for palatal fistulae closure

La fístula buconasal representa una de las secuelas más comunes luego de la reconstrucción primaria del paladar hendido. Su tratamiento es primordial para el adecuado funcionamiento del aparato estomatognático. Propósito: determinar la efectividad del colgajo de lengua para el cierre de fístulas palatinas en pacientes con secuela de paladar hendido. Caso clínico: se describe el procedimiento quirúrgico realizado a una paciente de 14 años de edad, que presentaba una fístula palatina anterior, con intentos de cierre previos sin éxito. La lesión fue tratada bajo anestesia general, realizando un colgajo de lengua de base anterior con cierre en dos planos. Resultado: se obtuvo un cierre satisfactorio de la lesión, evidenciando ausencia de la comunicación buconasal. Conclusión: el colgajo de lengua representa una alternativa quirúrgica para el cierre de la fístula palatina, principalmente en aquellos casos donde otros procedimientos han fracasado.

Colgajo de lengua como alternativa quirúrgica para el cierre de fístulas palatinas / Tongue flap as a surgical alternative for palatal fistulae closure

La fístula buconasal representa una de las secuelas más comunes luego de la reconstrucción primaria del paladar hendido. Su tratamiento es primordial para el adecuado funcionamiento del aparato estomatognático. Propósito: determinar la efectividad del colgajo de lengua para el cierre de fístulas palatinas en pacientes con secuela de paladar hendido. Caso clínico: se describe el procedimiento quirúrgico realizado a una paciente de 14 años de edad, que presentaba una fístula palatina anterior, con intentos de cierre previos sin éxito. La lesión fue tratada bajo anestesia general, realizando un colgajo de lengua de base anterior con cierre en dos planos. Resultado: se obtuvo un cierre satisfactorio de la lesión, evidenciando ausencia de la comunicación buconasal. Conclusión: el colgajo de lengua representa una alternativa quirúrgica para el cierre de la fístula palatina, principalmente en aquellos casos donde otros procedimientos han fracasado.(AU)