Hematoma de la funduplicatura de Nissen / Hematoma of a Nissen fundoplication

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Fluoroscopy and endoscopy-guided transanastomotic rendezvous: a novel technique for recanalization of a completely obstructed colorectal anastomosis.

BACKGROUND: Colorectal anastomotic stricture is a frequent complication that may affect up to 30% of patients. However, a complete obstruction is rare. Endoscopic balloon dilation is the first-line therapy, but it invariably requires being able to cross the stricture with the dilation device. When this is not possible, surgical revision is the alternative, but it is associated with higher morbidity. CASE PRESENTATION: A 76-year-old male patient underwent an urgent high anterior resection with transverse loop colostomy for an occlusive high rectal tumor. On postoperative day 8, he presented with anastomotic leakage and abscess formation, requiring percutaneous drainage. Ten months after surgery, a colonoscopy revealed a complete stricture of the anastomosis, refractory to negotiation of a guide wire, thus precluding balloon dilation. Hence, a modified rendezvous technique was planned. Simultaneously, a flexible endoscope and a rigid rectoscope were progressed through the distal loop colostomy, and the anus, respectively. A needle device was introduced through the rectoscope and used to pierce the colonic stump. A guide wire was progressed, and the stricture was dilated with a controlled radial expansion balloon catheter. Finally, a 12-Fr Foley catheter was left through the anastomosis. A total of three endoscopic balloon dilation sessions were completed, and successful colostomy reversal was carried out 10 days after the last session. CONCLUSION: Fluoroscopy-endoscopy-guided recanalization is an effective and safe treatment option for complete colorectal anastomotic stricture.

Contexto ocupacional, abuso y mal uso vocal en profesores de la ciudad de Iquique / Occupational context, vocal abuse and misuse in school teachers in the city of Iquique

OBJETIVOS: Caracterizar los factores de riesgo de disfonía en el contexto ocupacional y las conductas de abuso y mal uso vocal en profesores. METODOLOGÍA: Estudio descriptivo, transversal, en el que se participaron 70 profesores de educación básica municipal de la ciudad de Iquique, Chile, a quienes se les aplicó una encuesta para detectar Factores Ocupacionales y Personales que afectan al Sistema Fonatorio. Los resultados se analizaron con el programa SPSS versión 19.0 mediante esta dística descriptiva. RESULTADOS: el 80% de los docentes encuestados no ha recibido ningún tipo de entrenamiento vocal. Las conductas de abuso y mal uso vocal más frecuentes son: aumentar la intensidad de la voz (72,8), gritar (57,1%), carraspear (41,1%) y bajo consumo de agua (75%). En el contexto ocupacional se encontró que el 82% utiliza su voz más de 6 horas diarias, el 75% indicó tener entre 35-41 alumnos por clase, el 90% trabaja en salas de clases construidas con material reverberante y el 58,5% trabaja bajo constantes corrientes de aire. CONCLUSIONES: Este estudio da cuenta de la falta de capacitación que poseen los docentes acerca del uso adecuado de su voz. Se presentan múltiples factores personales y laborales-ambientales que repercuten en la presencia de disfonía ocupacional.

PURPOSE: To characterize risk factors of dysphonia in the occupa tional context and vocal abuse and misuse in teachers. METHODS: Cross-sectional, descriptive study in which 70 teachers of municipal basic education from the city of Iquique, Chile, were interviewed to detect Occupational and Personal Factors affecting the Phonatory System. The results were analyzed with the SPSS program version 19.0 through descriptive statistics. RESULTS: 80% of teachers surveyed have not received any type of vocal training. The most frequent abuse and vocal misuse behaviors are: increase the intensity of the voice (72.8), shout (57.1%) clearing the throat (41.1%) and low water consumption (75%). In the occupational context, it was found that 82% used their voice more than 6 hours a day, 75% indicated having between 35-41 students per class, 90% working in classrooms built with reverberant material and 58.5% works under constant air cur rents. CONCLUSIONS: This study shows the lack of training that teach ers have about the proper use of their voice. There are multiple personal and labor-environmental factors that affect the presence of occupational dysphonia.

Larval habitat characteristics of the main malaria vectors in the most endemic regions of Colombia: potential implications for larval control.

BACKGROUND: Malaria incidence has recently decreased globally and, as malaria elimination is envisioned as a possibility by the health authorities, guidance is needed to strengthen malaria control strategies. Larval source treatment, which could complement routine vector control strategies, requires knowledge regarding the Anopheles larval habitats. METHODS: A cross-sectional study was conducted in three of the most malaria-endemic regions in Colombia. A total of 1116 potential larval habitats in 70 villages were sampled in three states located in western Colombia: Cordoba, Valle del Cauca and Nariño. RESULTS: Overall, 17.5 % (195) of the potential larval habitats were found positive for different Anopheles species. A total of 1683 larvae were identified belonging to seven species: Anopheles albimanus, Anopheles calderoni, Anopheles darlingi, Anopheles neomaculipalpus, Anopheles nuneztovari s.l., Anopheles pseudopunctipennis, and Anopheles triannulatus. The most widely distributed species was An. nuneztovari s.l., which was found mainly in human-made fishponds in Cordoba and temporary puddles in Valle del Cauca. Anopheles albimanus and An. calderoni were associated with human-made wells or excavation sites in Nariño. Cordoba displayed the greatest Anopheles species diversity with a total of six species (Shannon diversity index H': 1.063). Although Valle del Cauca had four species, one more than Nariño, the diversity was lower because only one species predominated, An. nuneztovari s.l. The larval habitats with the highest Shannon diversity index were lagoons (H': 1.079) and fishponds (H': 1.009) in Cordoba, excavation sites in Nariño (H': 0.620) and puddles in Valle del Cauca (H': 0.764). CONCLUSIONS: This study provides important information regarding the larval habitats of the main malaria vectors in the most malaria-endemic regions of Colombia, which will be useful in guiding larval control operations.