Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19 / Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic

ANTECEDENTES Y OBJETIVO: Durante la pandemia de COVID-19 se produce una reducción del material para la protección de los profesionales. La impresión 3D ofrece la posibilidad de compensar la escasez de algunos de los suministros. El objetivo es describir el papel de la impresión 3D en un servicio de salud durante la pandemia de COVID-19, con énfasis en proceso para desarrollar un producto final listo para ser implementado en el entorno clínico. MATERIALES Y MÉTODOS: Se formó un grupo de trabajo entre la administración sanitaria, clínicos y otras instituciones público-privadas de Cantabria coordinado en el Hospital virtual Valdecilla. El proceso incluyó la recepción de las propuestas de impresión, el conocimiento de los recursos de impresión en la región, la selección de los dispositivos, la creación de un equipo para cada proyecto, diseño de prototipos, evaluación y rediseño, fabricación montaje y distribución. RESULTADOS: Se producen 1) dispositivos que ayudan a prevenir el contagio de los profesionales: pantallas de protección facial (2.400 unidades), accesorios personalizados para fotóforos (20 unidades) y horquillas salvaorejas para mascarillas (1.200 unidades); 2) productos relacionados con la ventilación de pacientes infectados: conectores de sistemas de ventilación no invasiva entre tubuladura y mascarilla; y 3) hisopos oro y nasofaríngeos (7.500 unidades) para la identificación de portadoras del coronavirus con el objetivo de diseñar protocolos de actuación en las área clínicas. CONCLUSIONES: La impresión 3D es un recurso válido para la producción de material de protección de los profesionales cuyo suministro está reducido durante una pandemia

BACKGROUND AND OBJECTIVE: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. METHODS: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. RESULTS: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. CONCLUSIONS: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic

Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic. / Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19.

BACKGROUND AND OBJECTIVE: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. METHODS: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. RESULTS: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. CONCLUSIONS: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.

[Evaluation of efficacy and clinical impact of positron emission tomography with 18F fluoro-deoxyglucose (FDG) in patients with suspicion of recurrent laryngeal carcinoma]. / Evaluación de la eficacia y el impacto clínico de la tomografía de emisión de positrones (PET) con 18F fluoro-desoxiglucosa (FDG) en pacientes con sospecha de recurrencia de carcinoma de laringe.

AIMS: To evaluate the efficacy and clinical impact of FDG-PET in patients with suspected recurrent laryngeal carcinoma. MATERIALS AND METHODS: 15 patients, with suspicion of recurrent laryngeal carcinoma and ambiguous conventional imaging modalities. In all patients a whole body scan was performed with FDG-PET in fasting patients following i.v. administration of 370-444 MBq FDG. The results were confirmed by histology and clinical evolution (follow-up period > 12 months). RESULTS: Prevalence of recurrence was 86.6%. FDG-PET was positive in 13 patients, with confirmation in all cases, and 2 were true negative (TN). Overall sensitivity, specificity, PPV, NPV and accuracy were 100%. FDG-PET changed the modality of treatment in 10 patients (clinical impact 63.3%). CONCLUSIONS: FDG-PET has high clinical impact in patients with a suspicion of recurrent laryngeal carcinoma, and should be incorporated to the diagnostic protocols before making a therapy decision.

Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest.

Pneumothorax (PTX) in patients with penetrating thoracic trauma is routinely ruled out with serial chest radiographs (CXRs). This study examined the efficacy of a shortened time period between initial and follow-up radiographs. Patients with penetrating torso injuries treated at a Level-1 trauma center received a CXR during their initial evaluation. If no pneumothorax or hemothorax was noted, and the patient did not require immediate admission to the Intensive Care Unit or operating room, a repeat chest film was taken at 3 and 6 h. Findings were treated as clinically indicated, and patients were discharged home if the last radiograph revealed no evidence of pathology. Over a 15-month period, 116 patients were evaluated for penetrating thoracic injuries (93 stabbings, 23 gunshot wounds) and had no pneumothorax detected on initial CXR. Two patients had pneumothorax detectable only by computed tomography. One patient had a normal initial CXR, but developed a PTX on the 3-h film, requiring tube thoracostomy. No patients developed a PTX on the 6-h study that was not present on the initial or 3-h CXR. In conclusion, extending the time between initial and final CXRs to 6 h in patients with penetrating thoracic trauma provided no additional information that was not available on the 3-h film.

Approaches to cleft lip and palate repair.

Facial clefts remain one of the most common congenital anomalies encountered by plastic surgeons. Over the last few decades, surgical results have continued to improve due to the interdisciplinary approach to this complex clinical problem.

[Levels of the pineal hormone melatonin and its circadian variations in the cochlea of Wistar rats]. / Niveles de la hormona pineal melatonina y sus variaciones con el ritmo circadiano en cóclea de rata Wistar.

The normal inner ear contains different elements belonging to the immune system. Some pathology of the inner ear has been attributed to autoimmune mechanisms, both humoral and cellular. Melatonin, the principal hormone of the pineal gland, modulates the immune system, is involved in autoimmune processes, and mediates free-radical and interleukine production. In a study of the presence of melatonin in rat cochlea, a day-night rhythm of melatonin in cochlea was observed. Melatonin levels are high during dark periods and low during light periods. This rhythm is synchronic with peripheral melatonin circulation. More work, both experimental and clinical, is needed to determine the role of melatonin in the inner ear and its therapeutic usefulness.

[Melatonin in palate tonsils with recurrent acute tonsillitis and tonsillar hypertrophy]. / Melatonina en amígdalas palatinas de amigdalitis aguda recurrente e hipertrofia amigdalar.

Tonsils are a point of contact between the environment and the immune system. The pineal hormone melatonin is influenced by environmental dark-light variations and modulates the immune system. We measured the amount of melatonin present in pediatric tonsillar infectious and obstructive processes. The highest levels of tonsillar melatonin were found in tonsillar hypertrophy and the lowest levels in recurrent acute tonsillitis, with or without hypertrophy. Melatonin has an immunostimulative function and an antiapoptotic effect. The relationship between low tonsillar melatonin concentrations and infection, as well as high melatonin levels and increased tonsillar size is discussed.

[ORL pathology in cystic fibrosis]. / Patología ORL en la fibrosis quística.

We have studied during 1991 a randomized group of 25 cystic fibrosis children whose ages were between 1 and 18 years, analyzing the disease's ENT signs. We have found polyps in the 20% of the patients points up for its high incidence, and the practical absence of otologic, pharyngeal and laryngeal processes.

[Unusual congenital laryngeal anomalies: a review of 13 cases]. / Anomalías congénitas laríngeas raras: una revisión de 13 casos.

In this study we presents: 6 subglottic stenosis, 2 subglottic hemangiomas, 2 laryngeal webs, 2 laryngeal cysts and 1 laryngoesophageal cleft. Were diagnosed during laryngotracheobronchoscopies performed to 220 newborns and small children that showed as main finding: stridor, voice change or aspiration syndrome. The stenosis, hemangiomas and cleft were resolved spontaneously. In the webs and cysts surgical correction was required. Here we will expound upon clinical, diagnostical and therapeutic aspects of these rare congenital laryngeal anomalies.

[Histiocytosis X: problems of differential diagnosis in otorhinolaryngology]. / Histiocitosis X: problemas de diagnóstico diferencial en ORL.

Four cases of Histiocytosis X are presented here, with symptoms otorhinolaryngologic. The evolution has been good, so they have been without disease for three of four years. We are presenting the problem of differential diagnosis of this disease for ENT specialists and the delay in the diagnosis. All our cases were diagnosed after one year of the beginning of symptoms.

[Relapsing polychondritis. Apropos of a case]. / Policondritis recidivante. A propósito de un caso.

Relapsing polychondritis is not a very frequent systemic disease. Nevertheless, it has to be borne in mind since very often the first symptoms appear in the sphere of otorhinolaryngology. We are faced with the problem of differential diagnosis in a case which in the beginning seemed to be a neurological pattern. The definitive diagnosis was not established until 15 months after the appearance of the symptoms when, after several outbreaks, the clinical pattern was clearer. As we have to deal with a recurrent and systemic pathology whose diagnosis is eminently clinical, long-term pursuit and valuation are necessary to allow us to know the natural history of the disease as well as the reaction to the treatment.