Toxic megacolon: a potentially lethal condition. Case report.

Toxic megacolon denotes an abrupt non-obstructive distension of the colon, accompanied by systemic signs of toxicity. Mortality rates can soar as high as 7.9%. While primarily linked with chronic bowel conditions, the incidence attributed to Clostridioides difficile has surged due to the indiscriminate use of broad-spectrum antibiotics. Surgical intervention becomes necessary in the majority of cases. Herein, we illustrate the case of a 50-year-old female presenting with episodic epigastric pain lasting 9 h, vomiting, and watery bowel movements, devoid of peritoneal irritation findings and lacking a history of chronic intestinal inflammation. Under certain circumstances, toxic megacolon may manifest atypically, underscoring the importance of conducting a comprehensive medical history and clinical assessment. Moreover, it is imperative to solicit pertinent paraclinical investigations to address the patient holistically and foster a favorable clinical outcome.

Sialolipoma of the parotid gland: A rare entity. Case report.

INTRODUCTION AND IMPORTANCE: Lipomatous neoplasms of the parotid gland represent an exceptionally rare and often underdiagnosed category of tumors, accounting for an incidence ranging from 0.6 % to 4.4 % of all neoplasms detected within the parotid gland. Sialolipoma is defined as an uncommon variant of lipoma, characterized by a well-defined proliferation of mature adipocytes with secondary entrapment of salivary gland elements, including serous acini, ducts, and myoepithelial cells. CASE PRESENTATION: The current case pertains to a 17-year-old female who presented with a one-year history of enlargement in the left preauricular region. CLINICAL DISCUSSION: The case we present poses a complex diagnostic challenge due to two distinct characteristics. The diagnostic challenge lies in its remarkably low incidence and the propensity for confusion with pleomorphic adenoma, which is the most common tumor of the parotid gland. It is a benign disease entity characterized by the absence of dysplasia, in marked contrast to pleomorphic adenoma. CONCLUSIONS: The infrequency in the manifestation of these tumor types, coupled with their prolonged asymptomatic course, can pose a diagnostic challenge. Enhancing our knowledge to comprehensively delineate these entities is imperative to effectively address the diagnostic complexities from both clinical and histopathological standpoints.

Introduction of Breast Implants through the Abdominal Route: Analysis of a Cohort.

BACKGROUND: Simultaneous breast reshaping and abdominoplasty offer patients the opportunity to undergo body reshaping in a single surgical session involving one anesthesia induction and one incision. In Latin America, abdominal implant placement is an infrequently used technique, likely because there is little evidence on its efficacy and safety. This study aimed to evaluate the efficacy and safety of implant placement through the abdominal route. METHODS: A retrospective cohort was analyzed, including 350 records of patients who underwent abdominal breast implants from 2013 to 2021 with a minimum follow-up of 1 year. The procedure was performed under epidural anesthesia. RESULTS: No intraoperative complications were reported. After a minimum 12-month follow-up, complications were detected in 5% of cases; the most frequent was asymmetry (4.6%), followed by abdominal migration and one case of symmastia. During the follow-up period, no capsular contracture was detected in any case. A satisfaction percentage of 98.1% was obtained. The only independent factor associated with complications was distance from the sternal notch to the nipple-areola complex greater than 21 cm. CONCLUSION: In this case series, mammaplasty with abdominal implant placement was an effective and safe procedure, with reduced risk of infection or capsular contracture and no scarring in or near the breasts for patients with properly selected comorbidities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Case report on the diagnosis of vascular thoracic outlet syndrome followed by mechanical thrombectomy.

INTRODUCTION AND IMPORTANCE: The thoracic outlet syndrome is characterized by compression of the brachial plexus or subclavian vessels due to anatomical alterations of the thoracic cavity. Vascular presentation is rare and includes thromboembolism and edema in the upper limb, and the diagnosis is often elusive due to its rarity. In this case, we describe a vascular thoracic outlet syndrome presentation whose diagnosis through angiography was achieved after a mechanical thrombectomy. CASE PRESENTATION: We report a 43-year-old female patient with pain in the right upper limb, accompanied by edema and mild violet discoloration, without risk factors for hypercoagulability, with D-dimer levels within normal values. Mechanical thrombectomy with AngioJET was performed via an endovascular approach, with the extraction of multiple clots, confirming the presence of thoracic outlet syndrome as the underlying cause of the current condition. CLINICAL DISCUSSION AND CONCLUSIONS: Venous thoracic outlet syndrome is a challenging entity to diagnose; however, it should be considered in cases of deep vein thrombosis of the subclavian vein and confirmed by angiography after a thrombectomy.

Sternal dehiscence, a reconstructive challenge. Case report.

INTRODUCTION AND IMPORTANCE: Sternotomy is the main surgical procedure used to access the heart and great vessels. Among its most important complications is post-sternotomy dehiscence with an incidence of 10 %; the main risk factors for its occurrence are diabetes mellitus, obesity or chronic obstructive pulmonary disease. CASE PRESENTATION: We present a clinical case of a 74-year-old male patient with sternal dehiscence secondary to sternotomy for myocardial revascularisation. CLINICAL DISCUSSION AND CONCLUSIONS: Surgical dehiscence of sternotomy presents remarkable complexity and poses a significant challenge to the medical team. The therapeutic approach focuses on addressing the infection, removing the necrotic tissue and then covering the area with highly vascularised tissue. Surgical alternatives include the possibility of using a unilateral pectoralis muscle flap, an option that provides adequate sternal stability and leads to satisfactory functional and cosmetic results.

Hepatic subcapsular hematoma following endoscopic retrograde cholangiopancreatography. Report of two cases.

INTRODUCTION AND IMPORTANCE: Hepatic subcapsular hematomas (HSH) are an extremely rare post-endoscopic retrograde cholangiopancreatography (ERCP) complication. Mortality exhibits disparities depending on the integrity of the hepatic capsular envelope, with ruptured HSH being associated with higher case fatality rates (2.2 % compared to 21.4 %). CASES PRESENTATION: Two clinical cases are presented concerning a 20-year-old female patient and a 40-year-old male patient, who were diagnosed with choledocholithiasis and underwent ERCP procedures with the use of a wide-bore guidewire (WBG), with the undesired result of HSH as a complication. In both scenarios, a surgical approach strategy was chosen to manage this situation. The outcome turned out to be successful in the first case, in contrast to the unfortunate death of the patient in the second case. CLINICAL DISCUSSION AND CONCLUSIONS: Conservative approaches prevail in the management of HSH, as they often present intact, resulting in a low mortality rate. However, surgical approaches are reserved for consideration in situations of hemodynamic instability that persists despite the conservative measures implemented.

Traumatic abdominal wall hernia: Case report of atypical origin.

INTRODUCTION AND IMPORTANCE: Traumatic abdominal wall hernia (TAWH) is an injury that occurs after an abdominal wall blunt trauma consisting of fasciomuscular rupture and does not present skin penetration. Documenting unique and rare clinical cases, such as traumatic hernia without skin penetration, enriches the medical literature and provides valuable information to identify innovative and optimised approaches for the treatment of similar cases in the future. CASE PRESENTATION: 48-year-old female with no significant medical history presented to the emergency room after being directly hit by a 1200 kg vehicle while standing in the street. Clinical examination revealed a TAWH with total elevation and total loss of insertion of all abdominal wall muscles on the right side, and no involvement of the overlying skin secondary to the mechanism of trauma. The patient agreed to surgical management after being thoroughly informed about the procedure. Surgical exploration was performed with the patient in a lateral position, and the incision was made over the hernia sac. A monopolar electrocautery was used to expose the iliac crest and fully visualize the defect before drilling through the iliac crest. Soft macroporous polypropylene mesh repair was guided through the iliac crest and abdominal wall using a suture and secured with knots. The patient showed a satisfactory and favorable progress. DISCUSSION AND CONCLUSIONS: The present surgical technique is recommended for atypical cases of high-strength TAWH.

Surgical technique for margin widening in the treatment of polypoid nodular malignant back melanoma.

INTRODUCTION AND IMPORTANCE: Nodular melanoma is the second most frequent cutaneous melanoma worldwide and due to its rapid growth rate and non-malignant appearance, is the most aggressive one. In its polypoid form, it is usually found in mucosal areas, but can also be seen on the trunk. This case is presented because it is an unusual manifestation and surgical treatment required wide excision, however, the patient's evolution is favorable. CASE PRESENTATION: 70-year-old female patient shows a progressively growing lesion with irregular border, abnormal color and a heterogeneous appearance. The biopsy yields the histological diagnosis of nodular polypoid melanoma. The surgical technique results in the resection of a 10 × 9 × 67 cm piece with favorable evolution of the patient. CLINICAL DISCUSSION AND CONCLUSIONS: The surgical technique of margin widening is considered a recommended option for polypoid nodular back melanomas. Although the excision is considered vast, the patient's evolution may turn out to be favorable.

Effect of sitagliptin on down-regulation of KAT7 and SIRT1 gene expression in breast cancer cell line MCF7.

BACKGROUND: To date, the main clinical interest in DPP4 is focused on its inhibition in diabetic patients to prolong the half-life of incretins. Epigenetic alterations resulting from DPP4 inhibition have been poorly explored. OBJECTIVE: The objective of this study was to determine, whether sitagliptin, a DPP4 inhibitor, has effects on the expression of KAT7 and SIRT1 (genes encoding a histone acetyltransferase and a histone deacetylase, respectively) in MCF7 breast cancer cells, which play an essential role in modulating the epigenetic landscape of chromatin. MATERIAL AND METHODS: MCF7 cells were incubated for 20 h with sitagliptin at concentrations of 0.5, 1.0 and 2.0 µM. Total RNA was isolated and the relative mRNA expression of KAT7 and SIRT1 was determined by RT-qPCR. RESULTS: There was downregulation in the relative expression of both genes; for KAT7, downregulation reached up to 0.49 (p = 0.027) and for SIRT1, it reached up to 0.55 (p = 0.037). CONCLUSIONS: These results suggest that sitagliptin has effects on the histone epigenetic landscape. This topic deserves further study due to the current sample use of DPP4 inhibitors in diabetic patients.

ANTECEDENTES: Hasta la fecha, el principal interés clínico de la DPP4 se centra en su inhibición en pacientes diabéticos para prolongar la vida media de las incretinas. Las alteraciones epigenéticas resultantes de la inhibición de DPP4 han sido poco exploradas. OBJETIVO: Determinar si la sitagliptina, un inhibidor de DPP4, tiene efectos sobre la expresión de KAT7 y SIRT1 (genes que codifican una histona acetiltransferasa y una histona desacetilasa, respectivamente) en células de cáncer de mama MCF7, que desempeñan un papel esencial en la modulación del paisaje epigenético de la cromatina. MÉTODO: Las células MCF7 se incubaron durante 20 h con sitagliptina a concentraciones de 0.5, 1.0 y 2.0 µM. Se aisló el ARN total y se determinó la expresión relativa de ARNm de KAT7 y SIRT1 mediante RT-qPCR. RESULTADOS: Hubo una regulación a la baja en la expresión relativa de ambos genes; para KAT7, la regulación negativa alcanzó hasta 0.49 (p = 0.027) y para SIRT1 alcanzó hasta 0.55 (p = 0.037). CONCLUSIONES: Estos resultados sugieren que la sitagliptina tiene efectos sobre el paisaje epigenético de las histonas. Este tema merece más estudios debido al uso actual de inhibidores de DPP4 en pacientes diabéticos.

Effectiveness of mini-transverse incision versus traditional reduced technique in the treatment of carpal tunnel syndrome. A prospective cohort study.

BACKGROUND: Carpal tunnel syndrome has attracted attention as an occupational disease due to the dramatic increase on its magnitude, and its prevalence in the general population, who's has been reported from a 0.6 to 3.4%. Currently, there are various techniques for its approach. However, there is great controversy when it comes to establishing which of the methods is the most beneficial. The objective of this study was to compare the efficacy of the mini-transverse incision against the traditional longitudinal technique in treatment of carpal tunnel syndrome. MATERIALS AND METHODS: A series of cases is presented, prospectively included, of patients with a diagnosis of carpal tunnel syndrome, who are beneficiaries of a government hospital. We present a series of cases with a diagnosis of carpal tunnel syndrome, which were performed with two different techniques. Both techniques were evaluated by comparing the recovery and work reintegration times, as well as the decrease in pain and the absence of complications. RESULTS: A total of 8 patients operated with a minimal incision and 9 with a traditional reduced incision were studied. Significant differences were shown in the days taken to return to work, with a median of 17.5 (q25-q75 14-21) days for mini-transverse incision group and of 28 (q25-q75 21-28) days for the longitudinal traditional incision group (p = 0.002). Likewise, differences were obtained in the visual analogue pain scale during the first week of evaluation 4 vs 7 (p = 0.000), in contrast to complications where there were no differences at all. CONCLUSION: The results obtained corroborate a greater efficacy of the mini-transverse incision technique, in reducing disability times. This favors the health institution to reduce the costs of rehabilitation and for the patient to have a prompt work reintegration. It is suggested to strengthen the scientific evidence that supports the use of this technique by exploring other areas such as functional status or long-term benefits.

Differential Methylation in Promoter Regions of the Genes NR3C1 and HSP90AA1, Involved in the Regulation, and Bioavailability of Cortisol in Leukocytes of Women With Preeclampsia.

Introduction: Hypertensive disorders are of interest in obstetrics and gynecology because they are the second place among causes of maternal mortality and a source of complications in the short, mid, and long term. Even if the pathophysiological process behind preeclampsia (PE) is still unknown, stress factors have been revealed to play an important role in the genesis of this pathologic process. Methods: A case-control study was designed with the purpose of determining if there is a differential methylation in NR3C1, HSD11B2, CYP11A1, CRHBP, TEAD3, and HSP90AA1 genes, related to signaling of the hypothalamic-pituitary-adrenal axis, and its regulation on early-onset PE (EOPE). Results: A total of 20 cases and 20 controls were studied by DNA methylation analysis, demonstrating differences among groups in the percentage of methylation of the NR3C1 gene. After a contingency analysis, an odds ratio (OR) for PE of 12.25 was identified for NR3C1 and 9.9 for HSP90AA1 genes. NR3C1, TEAD3, and HSP90AA1 genes showed a positive correlation with the systolic and diastolic blood pressure levels with a p ≤ 0.05. Conclusion: This study found a differential methylation in the glucocorticoid receptor (GR) NR3C1 and its co-chaperone HSP90AA1 in women with PE, with a possible regulatory role in the response to stress in pregnancy and is a likely physiopathological mechanism in PE.