RESUMEN
La membrana duodenal congénita se presenta con mayor frecuencia en la región ampular, y se expresa clínicamente como obstrucción intestinal durante el periodo neonatal. En algunos escenarios el diagnóstico de esta condición clínica pasa inadvertida cuando dicha membrana es incompleta, como en los casos de membrana duodenal fenestrada. En consecuencia, se modifica la forma de presentación y se dificulta su diagnóstico temprano. Se cuenta con distintos accesos terapéuticos para esta enfermedad, desde los abiertos, hasta los endoscópicos y laparoscópicos. Se presenta el caso de una lactante con diagnóstico tardío de membrana duodenal fenestrada, que se trató quirúrgicamente mediante acceso laparoscópico.
Congenital duodenal membrane is more frequently seen in the ampullary region and is clinically expressed as intestinal obstruction in the neonatal period. In some settings, the diagnosis of this clinical condition is glossed over when the membrane is incomplete as it happens in fenestrated duodenal membrane. Consequently, its way of presentation changes and thus the early diagnosis becomes difficult. There are different therapeutic accesses to this disease, from open to endoscopic and laparoscopic ones. This is a nursling who was lately diagnosed as fenestrated duodenal membrane case and was surgically treated through the laparoscopic access.
RESUMEN
Objetivo: Demostrar el manejo laparoscópico tardío en la reparación de una hernia postraumática gigante. Sede: Hospital CIMA Chihuahua, Tercer Nivel de Atención. Diseño: Descripción de caso. Descripción del caso. Paciente masculino de 41 años de edad, que 7 años previos participó en accidente automovilístico de frente con pérdida de la conciencia. Cuatro meses antes de su manejo comienza con pérdida de peso y una incapacidad importante para mantener los alimentos en el estómago. Se realiza serie esófago-gastroduodenal presentando hernia diafragmática gigante, vólvulo gástrico, la TAC evidencia orificio herniario en hemidiafragma izquierdo con vólvulo gástrico en el hemitórax derecho. Se realiza el tratamiento quirúrgico por abordaje laparoscópico, presentando un derrame pleural bilateral que, al 5º día de postoperado, se mantenía sólo en el lado izquierdo, resolviéndose en su totalidad a los 15 días de postoperado. Conclusiones: Cuando hablamos que una hernia diafragmática postraumática no es diagnóstica de manera inmediata al evento, entonces podemos hablar que el padecimiento se convierte en un problema crónico. La reparación de las hernias diafragmáticas postraumáticas, aunque técnicamente con mayor complejidad, tienen como alternativa la vía laparoscópica y la colocación de materiales protésicos con buenos resultados a corto y mediano plazo, convirtiéndose, en manos expertas y centros hospitalarios adecuados, en el estándar de oro para el manejo de las mismas.
Objective: To demonstrate the late laparoscopic handling for the repair of a post-traumatic giant hernia. Setting: Hospital CIMA Chihuahua, third level health care. Design: Case description. Case description. Male patient, 41-year-old, who 7 years before had been involved in a frontal automotive collision with loss of consciousness. Four months before his management, he started with weight loss and inability to retain food in the stomach. An esophageal-gastro-duodenal series was performed, which revealed a giant diaphragmatic hernia, gastric volvulus, the CAT scan evidenced hernia orifice in the left hemidiaphragm with gastric volvulus in the right hemithorax. Surgery was performed using a laparoscopic approach; the patient presented a bilateral pleural effusion, which on the 5th of surgery was restricted to the left side only, and resolving 15 days after surgery. Conclusions: When stating that a post-traumatic diaphragmatic hernia is not diagnostic immediately after the event, then we can say that it has become a chronic problem. Repair of post-traumatic diaphragmatic hernias, although technically more complex, have as alternative the laparoscopic route and placement of prosthetic materials with good short- and median-term results, becoming the gold standard for their treatment when performed by expert hands and in appropriate medical centers.
RESUMEN
Presently, water contamination issues are of great concern worldwide. Mexico has not escaped this environmental problem, which negatively affects aquifers, water bodies and biodiversity; but most of all, public health. The objective was to determine the level of water contamination in six tributaries of the Conchos River and to relate their levels to human health risks. Bimonthly samples were obtained from each location during 2005 and 2006. Physical-chemical variables (temperature, pH, electrical conductivity (EC), Total solids and total nitrogen) as well as heavy metals (As, Cr, Cu, Fe, Mn, Ni, V, Zn, and Li) were determined. The statistical analysis considered yearly, monthly, and location effects, and their interactions. Temperatures differed only as a function of the sampling month (P < 0.001) and the pH was different for years (P = 0.006), months (P < 0.001) and the interaction years x months (P = 0.018). The EC was different for each location (P < 0.001), total solids did not change and total nitrogen was different for years (P < 0.001), months (P < 0.001) and the interaction years x months (P < 0.001). The As concentration was different for months (P = 0.008) and the highest concentration was detected in February samples with 0.11 mg L(-1). The Cr was different for months (P < 0.001) and the interaction years x months (P < 0.001), noting the highest value of 0.25 mg L(-1). The Cu, Fe, Mn, Va and Zn were different for years, months, and their interaction. The highest value of Cu was 2.50 mg L(-1); for Fe, it was 16.36 mg L(-1); for Mn it was 1.66 mg L(-1); V was 0.55 mg L(-1); and Zn was 0.53 mg L(-1). For Ni, there were differences for years (P = 0.030), months (P < 0.001), and locations (P = 0.050), with the highest Ni value being 0.47 mg L(-1). The Li level was the same for sampling month (P < 0.001). This information can help prevent potential health risks in the communities established along the river watershed who use this natural resource for swimming and fishing. Some of the contaminant concentrations found varied from year to year, from month to month and from location to location which necessitated a continued monitoring process to determine under which conditions the concentrations of toxic elements surpass existing norms for natural waters.