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Objective: Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design: The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting: Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results: More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion: This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.
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Electrosurgical unit (ESU) is a critical piece of equipment in any endoscopy rooms because is used in the ma- jority of endoscopic therapeutic procedures. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. A good understanding of the principles of electrosurgery and various configurations available in the ESU is essential for the effective and safe use during endoscopy. The aims of these article are to: (1) expose physical principles relevant to the understanding of elec- trosurgery during endoscopy; (2) describe and provide practical recommendations regarding two ESU that are commonly in use; (3) review usually factors relevant to commonly performed therapeutic procedures, including polypectomy, sphincterotomy, contact thermal hemostasis, argon plasma coagulation, etc. (4) discuss the clinical relevance of technologies recently implemented in newer electrosurgical units and future perspectives with the artificial intelligence.
La unidad electroquirúrgica (UEQ) es un equipo fundamental en cualquier sala de endoscopia, ya que se utiliza en la mayoría de los procedimientos terapéuticos. Sin embargo, muchos endoscopistas no están del todo capacitados en su uso y sus bases físicas no suelen estudiarse ni comprenderse adecuadamente. Un buen conocimiento de los principios electroquirúrgicos y de las diversas configuraciones disponibles en la UEQ es esencial para un uso eficaz y seguro durante la endoscopia. Los objetivos de este artículo son: (1) Exponer los principios físicos relevantes de la electrocirugía durante la endoscopia; (2) Describir y proporcionar recomendaciones prácticas con respecto a las dos UEQ más comúnmente utilizadas; (3) Revisar los factores generalmente relevantes para los procedimientos terapéuticos que se realizan con frecuencia, incluida la polipectomía, la esfinterotomía, la hemostasia térmica de contacto, la coagulación con argón plasma, etc. (4) Analizar la relevancia clínica de las tecnologías implementadas recientemente en las UEQ más nuevas y las perspectivas futuras con el advenimiento de la inteligencia artificial.
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Eletrocirurgia/métodos , Endoscopia/instrumentação , Fatores de Risco , Eletrocirurgia/tendências , Endoscopia/métodosRESUMO
Background:: Epithelial tumors of the salivary glands, including benign tumors and aggressive malignancies with different prognoses, are uncommon. Aim: To describe the frequency and distribution of salivary gland tumors according to age, gender and anatomical location. Material and Methods: Review of pathological reports of salivary gland tumors of a Pathology laboratory at a clinical hospital from 2006 to 2016. Results: Five hundred ninety salivary gland biopsies were reviewed. Of these, 286 (49%) were primary epithelial tumors of the salivary glands. Two hundred thirty (80%) were benign and 56 (20%) were malignant tumors. Regarding location, 274 (96%) were in the major salivary glands, and 12 (4%) in the minor salivary glands. The most common histological types were pleomorphic adenoma for benign tumors in 172 cases, followed by papillary cystadenoma lymphomatosum in 33 cases. Mucoepidermoid carcinoma was the most common malignant tumor in 14 cases. Conclusions: These results are similar to reports from abroad, however more studies are necessary to be able to establish a more representative and updated analysis.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias das Glândulas Salivares/epidemiologia , Carcinoma/epidemiologia , Adenoma Pleomorfo/epidemiologia , Biópsia , Neoplasias das Glândulas Salivares/patologia , Carcinoma/patologia , Chile/epidemiologia , Estudos Transversais , Distribuição por Sexo , Distribuição por Idade , Adenoma Pleomorfo/patologiaRESUMO
INTRODUCTION: Lesch-Nyhan syndrome (LNS) is an inherited recessive X-related disorder caused by the deficiency of the enzyme hypoxanthin-guanine phosphorribosyl transferase (HPRT). Compul sive self-mutilation and dystonia occurs before the first year of age and is expressed by persistent bites on the oral mucosa, lips, tongue, fingers, and shoulders. The dental intervention performed on most of these patients is multiple tooth extraction to prevent serious secondary lesions. OBJECTIVE: To present a clinical case of LNS and describe pediatric dentistry management in patients with self-mutilating behavior. CLINICAL CASE: Male patient, 7 years old, LNS carrier. He was referred to the Dental Unit from the Department of Pediatric Neurology for evaluation and management of self-inflicted wounds on fingers, lips and cheeks associated with weight loss and decreased food intake. The surgical procedure consisted of multiple extractions, surgical remodeling of the residual alveolar ridges under general anesthesia. In the second postoperative month, the patient was discharged definitively, with an adequate nutritional status and no signs of self-mutilation in hands or oral cavity. CONCLUSIONS: Although LNS is rare, it is essential to know how to proceed in order to provide the best quality of life for patients and their families. Early tooth extractions, as an initial phase in severe cases, seem to be the most useful alternative to minimize damage.
Assuntos
Síndrome de Lesch-Nyhan/psicologia , Comportamento Autodestrutivo/etiologia , Extração Dentária , Criança , Humanos , Masculino , Comportamento Autodestrutivo/cirurgiaRESUMO
Resumen: Introducción: El síndrome de Lesch-Nyhan (SLN) es un trastorno hereditario recesivo relacionado con el cromosoma X, causado por la deficiencia de la enzima hipoxantina-guanina fosforribosil transferasa (HPRT). La automutilación compulsiva y distonía ocurre antes del año de edad y se expresa con mordeduras persistentes en la mucosa oral, labios, lengua, dedos y hombros. La intervención odontológica realizada en la mayoría de estos pacientes es la extracción dental múltiple para prevenir lesiones graves secundarias. Objetivo: presentar un caso clínico de SLN y describir el manejo odonto-pediátrico en pacientes con conducta automutilatoria. Caso clínico: Paciente varón, 7 años de edad, portador de SLN. Fue referido a la Unidad de Odontología desde el Departamento de Neurología Pediátrica para la evaluación y manejo de heridas autoinfligidas en dedos, labios y mejillas asociadas a una pérdida de peso y disminución de la ingesta de alimentos. El procedimiento quirúrgico consistió en extracciones dentales múltiples, y remodelación quirúrgica de las crestas alveolares residuales, bajo anestesia general. Al segundo mes posquirúrgico el paciente fue dado de alta definitivamente, con un adecuado estado nutricional y sin signos de automutilación en manos ni en cavidad oral. Conclusio nes: A pesar, que el SLN es infrecuente, es esencial saber cómo proceder para dar la mejor calidad de vida a los pacientes y sus familias. Las extracciones tempranas del diente, como fase inicial en casos severos, parecen ser la alternativa más útil para minimizar el daño y el dolor por la automutilación.
Abstract: Introduction: Lesch-Nyhan syndrome (LNS) is an inherited recessive X-related disorder caused by the deficiency of the enzyme hypoxanthin-guanine phosphorribosyl transferase (HPRT). Compul sive self-mutilation and dystonia occurs before the first year of age and is expressed by persistent bites on the oral mucosa, lips, tongue, fingers, and shoulders. The dental intervention performed on most of these patients is multiple tooth extraction to prevent serious secondary lesions. Objective: To present a clinical case of LNS and describe pediatric dentistry management in patients with self-mutilating behavior. Clinical case: Male patient, 7 years old, LNS carrier. He was referred to the Dental Unit from the Department of Pediatric Neurology for evaluation and management of self-inflicted wounds on fingers, lips and cheeks associated with weight loss and decreased food intake. The surgical procedure consisted of multiple extractions, surgical remodeling of the residual alveolar ridges under general anesthesia. In the second postoperative month, the patient was discharged definitively, with an adequate nutritional status and no signs of self-mutilation in hands or oral cavity. Conclusions: Although LNS is rare, it is essential to know how to proceed in order to provide the best quality of life for patients and their families. Early tooth extractions, as an initial phase in severe cases, seem to be the most useful alternative to minimize damage.
Assuntos
Humanos , Masculino , Criança , Extração Dentária , Comportamento Autodestrutivo/etiologia , Síndrome de Lesch-Nyhan/psicologia , Comportamento Autodestrutivo/cirurgiaRESUMO
BACKGROUND: Epithelial tumors of the salivary glands, including benign tumors and aggressive malignancies with different prognoses, are uncommon. AIM: To describe the frequency and distribution of salivary gland tumors according to age, gender and anatomical location. MATERIAL AND METHODS: Review of pathological reports of salivary gland tumors of a Pathology laboratory at a clinical hospital from 2006 to 2016. RESULTS: Five hundred ninety salivary gland biopsies were reviewed. Of these, 286 (49%) were primary epithelial tumors of the salivary glands. Two hundred thirty (80%) were benign and 56 (20%) were malignant tumors. Regarding location, 274 (96%) were in the major salivary glands, and 12 (4%) in the minor salivary glands. The most common histological types were pleomorphic adenoma for benign tumors in 172 cases, followed by papillary cystadenoma lymphomatosum in 33 cases. Mucoepidermoid carcinoma was the most common malignant tumor in 14 cases. CONCLUSIONS: These results are similar to reports from abroad, however more studies are necessary to be able to establish a more representative and updated analysis.
Assuntos
Adenoma Pleomorfo/epidemiologia , Carcinoma/epidemiologia , Neoplasias das Glândulas Salivares/epidemiologia , Adenoma Pleomorfo/patologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma/patologia , Criança , Pré-Escolar , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Salivares/patologia , Distribuição por Sexo , Adulto JovemRESUMO
BACKGROUND: Intraductal stones, ductal abnormalities and pancreatic pseudocysts are part of chronic pancreatitis (CP). The goal of treatment is pain relief, resolution of local complications and relapse prevention. Endoscopic therapy (ET) can be considered in those who do not respond to medical treatment. AIM: To evaluate the indication, immediate and long-term results of ET in CP patients. PATIENTS AND METHODS: Review of a database of patients with CP analyzing results of ET in 18 patients aged 16 to 60 years (13 males). Demographics, etiology, endoscopic technique, indication for treatment, pain relief, relapses and complications were recorded. RESULTS: The etiology of CP was alcohol consumption in 5, idiopathic in 11, hereditary in one and autoimmune in one case. The follow-up period was 6 months to 14 years. Seven patients had diabetes mellitus type 3c and eight had moderate to severe exocrine pancreatic insufficiency. Pancreatic papillotomy was performed in all patients, with removal of some stones, without attempting a complete clearance of the pancreatic duct. In addition, a 7-10 French stent was placed in the main pancreatic duct in 15 patients with varying permanence (months to years). The stent was changed guided by recurrence of clinical symptoms. During the follow-up period, 10 patients remained asymptomatic and in three, pain or relapse were significantly reduced. Stenting failed in one patient for technical reasons. Two patients were operated. There were neither immediate nor late complications from ET. CONCLUSIONS: Long-lasting improvement of CP was observed in 13 of 18 patients treated with ET, without complications associated with the procedure.
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Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatite Crônica/cirurgia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória , Pancreatite Crônica/complicações , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/métodos , Stents/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
Reported seroprevalence of hepatitis E virus (HEV) in developed countries is between 0.3-53%. Published data relies on the assays used and its technical performance. Sensitivity on new available tests has improved, which has changed HEV seroprevalence around the world. We re-evaluated retrospectively, 178 serum samples of patients with previous anti HEV IgG determination between 2009 and 2012. Initial analysis was performed with ELISA kit Genelabs (Singapore), with 7.3% positivity. The reevaluation was done with ELISA kit AccuDiag TM HEV-IgG (Diagnostic Automation, United States), with reported sensitivity and specificity over 99.8%. With the new assay, 32.6% positive samples were found, significantly greater to the previous result (p<0.001) (4.5 times more). There were no differences in gender but a significant association between age and HEV IgG seropositivity was found (p<0.001). This suggests that previous testing might have underestimated HEV seroprevalence in Chile, which should be reevaluated using the new available test.
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Anticorpos Antivirais/sangue , Vírus da Hepatite E/imunologia , Hepatite E/epidemiologia , Imunoglobulina G/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Hepatite E/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Adulto JovemRESUMO
Background: Intraductal stones, ductal abnormalities and pancreatic pseudocysts are part of chronic pancreatitis (CP). The goal of treatment is pain relief, resolution of local complications and relapse prevention. Endoscopic therapy (ET) can be considered in those who do not respond to medical treatment. Aim: To evaluate the indication, immediate and long-term results of ET in CP patients. Patients and Methods: Review of a database of patients with CP analyzing results of ET in 18 patients aged 16 to 60 years (13 males). Demographics, etiology, endoscopic technique, indication for treatment, pain relief, relapses and complications were recorded. Results: The etiology of CP was alcohol consumption in 5, idiopathic in 11, hereditary in one and autoimmune in one case. The follow-up period was 6 months to 14 years. Seven patients had diabetes mellitus type 3c and eight had moderate to severe exocrine pancreatic insufficiency. Pancreatic papillotomy was performed in all patients, with removal of some stones, without attempting a complete clearance of the pancreatic duct. In addition, a 7-10 French stent was placed in the main pancreatic duct in 15 patients with varying permanence (months to years). The stent was changed guided by recurrence of clinical symptoms. During the follow-up period, 10 patients remained asymptomatic and in three, pain or relapse were significantly reduced. Stenting failed in one patient for technical reasons. Two patients were operated. There were neither immediate nor late complications from ET. Conclusions: Long-lasting improvement of CP was observed in 13 of 18 patients treated with ET, without complications associated with the procedure.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatite Crônica/cirurgia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Consumo de Bebidas Alcoólicas/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Seguimentos , Dor Pós-Operatória , Pancreatite Crônica/complicações , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/métodos , Stents/efeitos adversos , Resultado do TratamentoRESUMO
Human fascioliasis is a parasitic zoonosis that affects the liver of human and herbivorous animals. In chronic cases, its diagnosis is confirmed by direct visualization of parasitic eggs in stool examination, by positive testing for Fasciola hepatica antigens in stools, or by direct observation of parasites by endoscopic retrograde cholangiography or surgery. In acute cases, serological reactions as immunoblothing or detection of parasite antigens in the blood are useful. The treatment of choice is triclabendazole. However, parasite resistance in animals, as well as in man, has been reported to this drug. We report four patients in whom the parasitic infection persisted despite a course of treatment with triclabendazole.
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anti-Helmínticos/administração & dosagem , Benzimidazóis/administração & dosagem , Resistência a Medicamentos , Fasciolíase/tratamento farmacológico , Fasciolíase/diagnósticoRESUMO
Human fascioliasis is a parasitic zoonosis that affects the liver of human and herbivorous animals. In chronic cases, its diagnosis is confirmed by direct visualization of parasitic eggs in stool examination, by positive testing for Fasciola hepatica antigens in stools, or by direct observation of parasites by endoscopic retrograde cholangiography or surgery. In acute cases, serological reactions as immunoblothing or detection of parasite antigens in the blood are useful. The treatment of choice is triclabendazole. However, parasite resistance in animals, as well as in man, has been reported to this drug. We report four patients in whom the parasitic infection persisted despite a course of treatment with triclabendazole.