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Purpose: To evaluate both the short-term clinical and radiological results of reverse shoulder arthroplasty (RSA) with uncemented locked stem in the management of a proximal humerus fracture (PHFs) in the elderly. Methods: Retrospective study including 40 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 24 months follow-up. In all the cases, the greater tuberosity (GT) was reattached with a standardized suture technique and a local horseshoe bone graft. All the patients were assessed at the 24-month follow-up with Constant-Murley Score (CMS) and Visual Analog Score (VAS). Radiographic healing of the greater tuberosity was noted in addition to stem locking screws radiographic changes. Complications and revision rates were reported. Results: Mean final CMS for this cohort was 80 points. The greater tuberosity healed in the anatomic position in 90% of the cases (N = 36), obtaining an average CMS of 80 in these patients. Healing of the greater tuberosity did not occur in 10% of the cases (N = 4), obtaining an average CMS of 60. All patients scored above 100° in forward elevation with a mean of 140°. Mean active external rotation was 30°. Low-grade scapular notching was reported in <1% of the cases. Major complications were reported in one patient with an acromial fracture. No complications or loosening of stem locking screws were noted. There were no reoperations. Conclusion: In the elderly population, reverse shoulder arthroplasty utilizing a fracture-specific locking stem, low-profile metaphysis, suture-friendly groove, meticulous suture technique, and local bone grafting allows adequate fixation, variable prosthesis height adjustment, and enhances greater tuberosity healing. This approach yields positive short-term clinical outcomes without complications related to the stem's locking screws. Level of Evidence: Level IV Retrospective Case Series.

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Background: The use of reverse total shoulder arthroplasty (RSA) for the treatment of proximal humeral fractures (PHFs) is steadily increasing. Better clinical outcomes of RSA have been correlated with tuberosity reattachment and healing. The purpose of this study was to evaluate both the clinical and radiological results of reverse shoulder arthroplasty in the management of a proximal humerus fracture in the elderly. Methods: Retrospective study including 400 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 12-month follow-up. In all the cases, the greater tuberosity was reattached with a standardized suture technique and a local bone graft. All the patients were assessed at the 12-month follow-up with Constant-Murley Score (CMS). Radiographic healing of the greater tuberosity was noted. Complications and revision rates were reported. Results: Mean final CMS for this cohort was 82 points. The greater tuberosity healed in anatomic position in 85% of the cases (N = 340), obtaining an average CMS of 85 in these patients. Healing of the greater tuberosity did not occur in 13% of the cases (N = 52) and displacement more than 5 mm occurred in 2% (N = 8) of the patients for an average CMS of 60. All patients scored above 120° in forward elevation with a mean of 150°. Mean active external rotation was 35°. The lateralization shoulder angle had a mean of 91° and the distalization shoulder angle had a mean of 54°. Low-grade scapular notching was reported in <1% of the cases. A total of 60 patients presented failure of healing or displacement of the greater tuberosity. Major complications were reported in nine patients. Of these nine patients, two acquired superficial wound infections, while two had deep shoulder prosthetic infection. Two other patients developed hematomas, one sustained an acromial stress fracture, and two had a stem loosening. There were 4 reoperations. Conclusion: Reverse shoulder arthroplasty, with the use of a fracture-specific stem, allows an improved rate of greater tuberosity healing and short-term clinical outcomes in the elderly population.

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This paper makes a critical review of educational and operational issues related with pandemic and postpandemic lessons in Latin American higher education institutions (LATAM HEI), as background for uncovering key elements to innovate educational practices in technology-mediated higher education. The authors adapted the reflexive pedagogy framework to conduct in depth analysis of innovation experiences mediated with educational technologies and draw conclusions for curricular and digital transformation of LATAM HEI.

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BACKGROUND: Leprosy, cutaneous leishmaniasis (CL) and Chagas disease (CD) are neglected tropical diseases with a high psychosocial burden (PSB). These conditions are endemic in Norte de Santander and Arauca in Colombia, but data on the related PSB are scarce. Therefore, we assessed mental distress, participation restriction and stigma among CD, CL and leprosy patients. METHODS: In 2018, 305 leprosy, CD or CL patients were interviewed using a self-report questionnaire to assess mental distress, participation scale for participation restriction and explanatory model interview catalogue (EMIC) for stigma. Descriptive statistics and the significance of median score differences were compared. RESULTS: Fifty percent of CD patients and 49% of leprosy patients exhibited mental distress, percentages which were significantly higher than that of CL (26%). Twenty-seven percent of leprosy patients experienced participation restriction, which was lower for CL (6%) and CD (12%). Median EMIC scores were significantly higher for leprosy patients than for CD (27%) and CL (17%) patients. CONCLUSIONS: We found high levels of PSB among leprosy, CD and CL patients. Mental distress was highest among CD patients. Participation restriction and stigma were more prevalent in leprosy patients. Rural residence or lower educational status may impact PSB. Further investigation is needed to formulate evidence-based, holistic interventions.

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BACKGROUND: Many neglected tropical diseases (NTDs) are not fatal, but they are disabling, disfiguring and stigmatizing. More accurate data on these aspects would benefit planning, monitoring and evaluation of interventions, as well as provision of appropriate services for the often life-long consequences. In 2015, a cross-NTD toolkit was developed, consisting of a variety of existing questionnaires to measure morbidity, disability and health-related quality of life. The toolkit covers the domains of the International Classification of Functioning, Disability and Health (ICF) framework. These tools have been developed in a source country, however, it was intended for the cross-NTD toolkit to be applicable across NTDs in many countries with different cultures and languages in order to generate universally comparative data. Therefore; the present study aimed to validate several tools of the toolkit among people affected by leprosy or leishmaniasis in the cultural settings of Cartagena and Cúcuta, Colombia. METHODOLOGY: This study aimed to validate the following tools among 55 participants between 18-85 years old, affected by leprosy and leishmaniasis: (I) Clinical Profile, (II) Self-Reporting Questionnaire (SRQ), (III) WHO Quality of Life assessment-abbreviated version (WHOQOL-BREF), and (IV) WHO Quality of Life assessment-Disability (WHOQOL-DIS). The tools were administered during face-to-face interviews and were followed by open questions about the respondents' thoughts on format of the tool and the understanding, relevance and acceptability of the items. The tools were validated using a qualitative method approach based on the framework for cultural equivalence, measured by the cultural, item, semantic and operational equivalences. RESULTS: The Clinical Profile was seen as acceptable and relevant, only the semantic equivalence was not as satisfying and needs a few adaptations. The SRQ was very well understood and shows to reach the equivalences for the population of Colombia without any additional changes. Several items of the WHOQOL-BREF and the WHOQOL-DIS were not well understood and changes are recommended due to semantic difficulties. Operational equivalence of both questionnaires was not as desired in relation to the used response scales. The participants shared that the tools are relevant and important for their particular situation. CONCLUSIONS/SIGNIFICANCE: The SRQ is found to be a valid tool for Colombia and can be included in the cross-NTD toolkit. The Clinical Profile, WHOQOL-BREF & WHOQOL-DIS need changes and retesting among Colombian people affected by an NTD. The toolkit as a whole is seen as useful to show the effects leprosy and leishmaniasis have on the participants. This cultural validation will contribute to a universally applicable cross-NTD toolkit.

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La tuberculosis continúa siendo un reto diagnóstico al presentarse con características clínicas poco usuales. Objetivo: exponer las características clínicas en un caso inusual de tuberculosis miliar, con diseminación genitourinaria. Presentación del caso clínico: p aciente masculino de 48 años, agricultor, de escasos recursos económicos, sin comorbilidades previas; presentó sintomatología constitucional, pérdida de peso, fiebre y dolor lumbar irradiado a ambos flancos de la región abdominal, de características específicas, de un mes de evolución, acompañado de disuria y oliguria, negó síntomas respiratorios. Al examen físico, luce crónicamente enfermo, en mal estado nutricional, sin deterioro de la conciencia, no evidenció adenopatías cervicales ni inguinales, sin presencia de signos pulmonares y con leve dolor renal bilateral a la puño percusión;en área genital se identifica una masa de borde regular, móvil, sobre el polo superior del testículo derecho. Examen hematológico, presencia de Bicitopenia (anemia microcitica hipocromica y trombocitopenia leve). Además con hiperazoemia e hiperkalemia en la bioquímica sanguínea refractaria al tratamiento; en gases arteriales acidosis metabólica con anión gap elevado, por lo que fue sometido a hemodiálisis aguda. A través de los estudios imagenológicos, por medio de la bacteria alcohol acido resistente de sedimento urinario seriado y la tinción Ziehl Neelsen en orina, se determinó el diagnóstico yse inició terapia antifimica. Conclusión: Es necesario considerar a la tuberculosis como diagnóstico diferencial, especialmente en presentaciones poco usuales, dado que es endémica en Honduras...(AU)

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OBJECTIVES: To determine the average time in months between the beginning of symptoms and the diagnostic confirmation of leprosy by the health system and to investigate factors associated with diagnostic delay. METHODS: A total of 249 patients older than 15 years diagnosed with leprosy between 2011 and 2015, in 20 endemic municipalities of north-eastern Colombia, provided informed consent and were interviewed face-to-face. Clinical histories from health centres or hospitals where study participants were treated for leprosy were also reviewed. RESULTS: The mean delay in diagnosis of leprosy was 33.5 months. About 14.9% of patients showed a visible deformity or damage (disability grade 2, DG2) at the time of diagnosis. In multivariable regression analysis, five or more consultancies required to confirm the diagnosis and not seeking care immediately after noticing first symptoms were associated with longer diagnostic delay. CONCLUSIONS: Our study found a significant delay in diagnosis of leprosy in north-eastern Colombia, which might explain the continuously high rate of DG2 among new cases being notified in the country. Both patient- and health system-related factors were associated with longer diagnostic delay. Interventions to increase awareness of disease among the general population and timely referral to a specialised health professional are urgently needed in our study setting.

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Antecedentes: A pesar de los grandes avances en la medicina contemporánea; la Tuberculosis continúa siendo un reto diagnóstico, en especial al presentarse con características clínicas poco usuales. Caso clínico: Paciente masculino de 48 años, agri-cultor, de escasos recursos económicos, sin comorbilidades previas, el cual presenta sintomatología constitucional, pérdida de peso, iebre y dolor lumbar irradiado a ambos lancos de la región abdominal, de características poco especíicas, de un mes de evolución; acompañado de disuria y oliguria, y niega síntomas respiratorios. Al examen físico luce crónicamente enfermo, en mal estado nutricio-nal, sin deterioro de la conciencia, no se evidencia adenopatías cervicales ni inguinales; sin presencia de signos pulmonares, con leve dolor con la puño percusión renal bilateral, en el área genital, se identiica una masa de borde regular, móvil sobre el polo superior del testículo derecho. En el examen hematológico con presencia de Bicitopenia anemia microcitica hipocromica y trombocitopenia leve, en gases arteriales acidosis metabólica con Anión Gap elevado, además con hiperazoemia e hiperkalemia en la bioquímica sanguínea refractaria al tratamiento, razón por la cual fue sometido a Hemodiálisis aguda. Al evaluar radiografía de tórax se observa patrón micro-nodular difuso, no se realiza baciloscopias por falta de expectoración ni por lavado gástrico, en el ultrasonido renal y de vías urinarias se visualizó nefromegalia y la presencia de masa heterogénea de aspecto granulomatoso en testículo derecho; por lo que se solicitó tomografía toracoabdominal, en donde se observa patrón micronodular múltiple a nivel pulmonar, con afectación renal, ganglionar y testicular, se solicita BAAR de sedimento urinario seriado con resultados positivos, y la tinción Ziehl Neelsen en orina con resultado positivo; con ello se inicia terapia antiimica. Discusión: La Tuberculosis renal no tiene un cuadro clínico clásico; generalmente se presenta con manifestaciones atípicas; como en nuestro caso con sintomatología urinaria, hiperazoemia que culmino en terapia de restitución renal de emergencia, con posterior recuperación de la función renal.

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Antecedentes: La hernioplastia inguinal ha experimentado dos importantes novedades en los últimos decenios: las técnicas sin tensión con el agregado de mallas de polipropileno y el abordaje laparoscópico de la intervención, que han tenido distinto grado de aceptación entre los cirujanos generales. En este trabajo investigamos el panorama actual sobre el tema en nuestro país entre los cirujanos de la Asociación Argentina de Cirugía (AAC), enfocando el estudio en su aprendizaje y los obstáculos para su empleo relacionados a costos y disponibilidad de insumos y equipamiento, para precisar sus indicaciones actuales y evaluar los beneficios de propender a su desarrollo. Objetivo: Analizar los resultados obtenidos de una encuesta efectuada a los cirujanos miembros de la AAC sobre la utilización de la malla de polipropileno y la vía laparoscópica en hernioplastia inguinal. Población: 559 cirujanos encuestados de la AAC. Método: Se envió por correo electrónico a los miembros de la AAC una encuesta con preguntas sobre sus indicaciones y frecuencia de empleo de malla de polipropileno y el abordaje laparoscópico para el tratamiento de la hernia inguinal en los últimos 3 años, así como las razones para no emplearlos. El cuestionario fue nuevamente enviado a los dos meses para lograr un mayor número de respuestas. Algunos de los datos obtenidos de los ítems preguntados se relacionaron entre sí para obtener nuevos datos surgidos de su combinación. Resultados: Hubo una tendencia creciente al empleo de la malla de polipropileno, registrándose que un 83,7% de los encuestados la había utilizado en más del 80% de sus operados en 2011. Entre las razones para no emplearla, se señalaron las administrativas en un 26,3% y la falta de experiencia en un 8,7%. La vía laparoscópica mantuvo su escasa aplicación y tuvo una tendencia al aumento de su empleo más moderada: así, un 65,7% de los encuestados no la realizó en 2011, siendo escasos los que la emplearon en el 50% o más de sus casos. Al respecto, los cirujanos que operaban más de 50 hernioplastias anuales la emplearon claramente con más frecuencia ( 46,4%). En cuanto a las razones para no haber realizado esta técnica, se señalaron las administrativas en un 48,3% y la falta de experiencia en un 25,8%, llegando esta última a un 56% entre los cirujanos menores de 40 años de edad. Las hernias bilaterales y las recidivadas sobresalieron netamente en las indicaciones de hernioplastia laparoscópica, y un 45% de los 559 encuestados manifestó interés en obtener experiencia en la técnica laparoscópica por medio de pasantías en servicios especializados o cursos "hands on". Conclusiones: La gran mayoría de los cirujanos generales de la AAC ha incorporado la malla de polipropileno a la hernioplastia inguinal y esta conducta ha seguido una tendencia creciente en los últimos 3 años. A pesar de que la hernioplastia laparoscópica también ha aumentado en los últimos 3 años, aún 2/3 de los cirujanos generales encuestados no la utilizaron en el 2011, siendo las razones administrativas su principal obstáculo y la falta de experiencia en la técnica la segunda causa individual en importancia. Actualmente esta técnica es realizada principalmente en centros de referencia y por los que tienen mayor número de hernioplastias en su práctica quirúrgica. Hubo un claro interés en los cirujanos generales jóvenes encuestados por aprenderla. En consecuencia, creemos, como otros autores, que debe hacerse un esfuerzo para desarrollar su enseñanza y entrenamiento y reducir su costo, para que el cirujano que desee emplearla pueda estar en condiciones de efectuarla con una técnica confiable.(AU)

Background: Inguinal hernia repair has experienced two important changes in the last decades which have gained different acceptance amongst general surgeons: the tension-free techniques with polypropylene meshes and the laparoscopic approach of the repair. In this study we investigated the actual view on the subject in our country amongst the members of the Argentine Association of Surgery (AAC), focusing the survey in the learning of the techniques and the obstacles for its employment related to cost and availability of supplies and equipment, to assess its current indications and the benefits of encouraging its development in the present times. Objective: To analyze the results of a questionnaire performed amongst members of the AAC, regarding the use of polypropylene mesh and the laparoscopic approach in inguinal hernia repair. Population: 559 surgeons, members of the AAC. Methods: A questionnaire was sent by mail to all members of the AAC regarding their indications and frequency of use of a polypropylene mesh and the laparoscopic approach for the treatment of inguinal hernia in the last 3 years, also inquiring about the reasons for not having employed them. The questionnaire was sent again two months later to attain a larger response rate. Some data were crossed amongst the items of the questionnaire to obtain new data emerging from their combination. Results: There was a tendency of more frequent use of the polypropylene mesh, 83.7% of surgeons having employed it in more than 80% of their patients in 2011. Amongst the reasons for not using it, administrative obstacles were pointed out in 26.3% of the responses and lack of experience in 8.7%. The laparoscopic approach remained of limited application, showing a moderate rise in the frequency of its use: 65% of the responders had not performed it in 2011, and few of them had used it in more than 50% of their cases. The laparoscopic approach was clearly more frequently employed (46.4%) amongst the surgeons that performed more than 50 hernioplasties a year. Regarding this technique, administrative obstacles were the reasons for not doing it in 48.3% of the responses and lack of experience in 25.8%, reaching up to 56% amongst surgeons of less than 40 years of age. Bilateral and recurrent hernias stood out clearly as the preferred indications for a laparoscopic hernioplasty, and 45% of the responders expressed an interest in obtaining experience in the laparoscopic technique, through training stays in specialized services or hands-on courses. Conclusions: The great majority of the general surgeons of the AAC has employed the polypropylene mesh for inguinal hernioplasty and this conduct has followed an increased tendency through the last 3 years. Although laparoscopic hernioplasty has also increased in frequency in the last 3 years, 2/3 of the surgeons that answered the questionnaire had not yet performed it in 2011, being the main obstacles administrative reasons and the lack of experience in the technique. Currently, laparoscopic hernioplasty is performed mainly in specialized centers and by those who have a greater number of hernioplasties in their surgical practice. There was a clear interest in young general surgeons of our survey in learning the laparoscopic technique. Consequently, we suggest, as other authors, that an effort should be made to develop its teaching and training and reduce its cost, to offer the surgeon who wishes to employ it the possibility to perform it with a reliable technique.

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Antecedentes: La hernioplastia inguinal ha experimentado dos importantes novedades en los últimos decenios: las técnicas sin tensión con el agregado de mallas de polipropileno y el abordaje laparoscópico de la intervención, que han tenido distinto grado de aceptación entre los cirujanos generales.En este trabajo investigamos el panorama actual sobre el tema en nuestro país entre los cirujanos de la Asociación Argentina de Cirugía (AAC), enfocando el estudio en su aprendizaje y los obstáculos para su empleo relacionados a costos y disponibilidad de insumos y equipamiento, para precisar sus indicaciones actuales y evaluar los beneficios de propender a su desarrollo.Objetivo: Analizar los resultados obtenidos de una encuesta efectuada a los cirujanos miembros de la AAC sobre la utilización de la malla de polipropileno y la vía laparoscópica en hernioplastia inguinal.Población: 559 cirujanos encuestados de la AAC. Método: Se envió por correo electrónico a los miembros de la AAC una encuesta con preguntas sobre sus indicaciones y frecuencia de empleo de malla de polipropileno y el abordaje laparoscópico para el tratamiento de la hernia inguinal en los últimos 3 años,así como las razones para no emplearlos. El cuestionario fue nuevamente enviado a los dos meses para lograr un mayor número de respuestas. Algunos de los datos obtenidos de los ítems preguntados se relacionaron entre sí para obtener nuevos datos surgidos de su combinación...

Background: Inguinal hernia repair has experienced two important changes in the last decades which have gained different acceptance amongst general surgeons: the tension-free techniques with polypropylene meshes and the laparoscopic approach of the repair.In this study we investigated the actual view on the subject in our country amongst the members of the Argentine Association of Surgery (AAC), focusing the survey in the learning of the techniques and the obstacles for its employment related to cost and availabilityof supplies and equipment, to assess its current indications and the benefits of encouraging its development in the present times.Objective: To analyze the results of a questionnaire performed amongst members of the AAC, regarding the use of polypropylene mesh and the laparoscopic approach in inguinal hernia repair.Population: 559 surgeons, members of the AAC.Methods: A questionnaire was sent by mail to all members of the AAC regarding their indications and frequency of use of a polypropylenemesh and the laparoscopic approach for the treatment of inguinal hernia in the last 3 years, also inquiring about the reasons for not having employed them. The questionnaire was sent again two months later to attain a larger response rate. Some data were crossed amongst the items of the questionnaire to obtain new data emerging from their combination...

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Introducción: La preparación mecánica del colón (PMC) es una práctica común, utilizada por la mayoría de los cirujanos. A pesar de no existir evidencia científica significativa que la avale, se ha convertido en un dogma en la última mitad de siglo XX. La factibilidad del abordaje laparoscópico sin PMC no está aún completamente aclarada. Objetivo: el objetivo del presente estudio es evaluar la factibilidad técnica, y la seguridad del abordaje laparoscópico en cirugía colorrectal sin preparación mecánica. Diseño: análisis retrospectivo y descriptivo, de una base de datos prospectiva. Población: 108 pacientes sometidos a colectomía laparoscópica, sin PMC. Métodos: Periodo analizado: Marzo de 2007 a Marzo de 2010, Forma de registro de datos: consecutiva, sucesiva y no selectiva en una base de datos prospectiva Excel 2011 para Mac. Se tatuaron en forma sistemática todas las lesiones que el cirujano consideró de difícil localización intraoperatoria. Se analizaron variables como edad, sexo, grado de ASA, índice de masa corporal (IMC), cirugías previas, patología, tipo y duración de cirugía, tasa de conversión y su causa. Se utilizó la escala de Dindo y Clavien para categorizar la morbilidad. Para simplificar el análisis se dividieron las colectomías en dos grupos. Los resultados se compararon con los hallados en la bibliografía. Resultados: La media de edad fue 60 años (24-84), el 60% de la serie eran hombres. El 6,5% (7) de los pacientes eran obesos. 37 pacientes (45%) tuvieron una categorización de la clasificación de ASA III o mayor. El 40 % tenían antecedentes de cirugías abdominales previas. El 68% de la patología fue oncológica. Se operaron de forma programada 104 pacientes. Se realizaron 70 anastomosis en 71 colectomías izquierdas y 33 derechas. La tasa de conversión global fue del 11% (12/108). En ningún caso el motivo fue por dificultad en la manipulación del colon...(AU)

The mechanical bowel preparation (MBP) is a common practice, used by most surgeons. Despite the absence, of significant scientific evidence, has become a dogma in the latter half of the twentieth century. The feasibility of the laparoscopic approach without MBP is not yet completely clarified. Aim: the objective of this study is to evaluate the technical feasibility, and the security of laparoscopy in colorectal surgery without mechanical preparation. Design: a Descriptive and retrospective analysis has been conducted from a prospective database. Population: 108 patients who underwent a laparoscopic colonic resection without MBP were analyzed. Methods: Period: March 2007 to March 2010. A consecutive, and unselective data was registered in a prospective Excel database. All lesions were tattooed when considered difficult to locate during surgery. Variables such a as age, gender, ASA, BMI, history of surgical treatment, histopathological results, type and length of surgery, convertion rate and its causes were analyzed. Dindo and ClavienÆs classification was used to categorized morbidity and mortality. In order to simplify the analysis, colectomies where dived into 2 groups: right and left procedures. Results were compared with the literature. Results: The average age found was 60 years (24-84), 60% of the patients were males. 6.5% were obese. According to the ASA classification, 37 patients (45%) were categorized as ASA III-IV. Forty percent had a history of abdominal surgeries. 68% of the surgical procedures were done for cancer. There were 104 programmed surgeries, 70 anastomosis were performed in 71 left colectomies and in 33 right colectomies. The global conversion rate was of 11% (12/108). None of this conversion was due to lack of small lesion identification. The surgical time was of 180Æ (85Æ-360Æ). Morbidity rate was 21% (23/108) and the mortality rate found was 0.9% (1/108)...(AU)

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Introducción: La preparación mecánica del colón (PMC) es una práctica común, utilizada por la mayoría de los cirujanos. A pesar de no existir evidencia científica significativa que la avale, se ha convertido en un dogma en la última mitad de siglo XX. La factibilidad del abordaje laparoscópico sin PMC no está aún completamente aclarada. Objetivo: el objetivo del presente estudio es evaluar la factibilidad técnica, y la seguridad del abordaje laparoscópico en cirugía colorrectal sin preparación mecánica. Diseño: análisis retrospectivo y descriptivo, de una base de datos prospectiva. Población: 108 pacientes sometidos a colectomía laparoscópica, sin PMC. Métodos: Periodo analizado: Marzo de 2007 a Marzo de 2010, Forma de registro de datos: consecutiva, sucesiva y no selectiva en una base de datos prospectiva Excel 2011 para Mac. Se tatuaron en forma sistemática todas las lesiones que el cirujano consideró de difícil localización intraoperatoria. Se analizaron variables como edad, sexo, grado de ASA, índice de masa corporal (IMC), cirugías previas, patología, tipo y duración de cirugía, tasa de conversión y su causa. Se utilizó la escala de Dindo y Clavien para categorizar la morbilidad. Para simplificar el análisis se dividieron las colectomías en dos grupos. Los resultados se compararon con los hallados en la bibliografía. Resultados: La media de edad fue 60 años (24-84), el 60% de la serie eran hombres. El 6,5% (7) de los pacientes eran obesos. 37 pacientes (45%) tuvieron una categorización de la clasificación de ASA III o mayor. El 40 % tenían antecedentes de cirugías abdominales previas. El 68% de la patología fue oncológica. Se operaron de forma programada 104 pacientes. Se realizaron 70 anastomosis en 71 colectomías izquierdas y 33 derechas. La tasa de conversión global fue del 11% (12/108). En ningún caso el motivo fue por dificultad en la manipulación del colon...

The mechanical bowel preparation (MBP) is a common practice, used by most surgeons. Despite the absence, of significant scientific evidence, has become a dogma in the latter half of the twentieth century. The feasibility of the laparoscopic approach without MBP is not yet completely clarified. Aim: the objective of this study is to evaluate the technical feasibility, and the security of laparoscopy in colorectal surgery without mechanical preparation. Design: a Descriptive and retrospective analysis has been conducted from a prospective database. Population: 108 patients who underwent a laparoscopic colonic resection without MBP were analyzed. Methods: Period: March 2007 to March 2010. A consecutive, and unselective data was registered in a prospective Excel database. All lesions were tattooed when considered difficult to locate during surgery. Variables such a as age, gender, ASA, BMI, history of surgical treatment, histopathological results, type and length of surgery, convertion rate and its causes were analyzed. Dindo and Clavien’s classification was used to categorized morbidity and mortality. In order to simplify the analysis, colectomies where dived into 2 groups: right and left procedures. Results were compared with the literature. Results: The average age found was 60 years (24-84), 60% of the patients were males. 6.5% were obese. According to the ASA classification, 37 patients (45%) were categorized as ASA III-IV. Forty percent had a history of abdominal surgeries. 68% of the surgical procedures were done for cancer. There were 104 programmed surgeries, 70 anastomosis were performed in 71 left colectomies and in 33 right colectomies. The global conversion rate was of 11% (12/108). None of this conversion was due to lack of small lesion identification. The surgical time was of 180’ (85’-360’). Morbidity rate was 21% (23/108) and the mortality rate found was 0.9% (1/108)...

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The coexistence of multiple chromosomal abnormalities and Congenital Varicella Syndrome (CVS) in one patient is a rare event in which anesthetic implications should be considered. This case report describes a 9-year-old female with CVS and a karyotype analysis of 6p21; 16p13 genetic translocations. We conducted a detailed investigation of the consequences of such findings and the potential outcomes in anesthesia of this uncommon incident including thorough research on the characteristics present in each condition. We concluded that: (1) coexistence of two genetic translocations (6p21; 16p13) in one patient, and simultaneously with CVS is undoubtedly an extremely rare event; (2) difficult airway management, potential cardiac dysfunction, risk of pulmonary aspiration, fluid disturbances, and a hard to access peripheral vascularity are among the most important anesthetic implications as a consequence of having all these disorders; (3) ketamine was a safety and efficacious option for sedation during fiber optic bronchoscopy.

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Incremental dosing of intrathecal local anesthetic for an indefinite duration performed during continuous spinal anesthesia (CSA) allows for better control of adverse effects caused by sympathetic nerve blockade. This case report describes a 91-year-old female with a left intertrochanteric fracture and a large thyroid mass causing contralateral anterior displacement of the trachea and the great vessels. We conducted a detailed investigation of the different techniques that can be used in such circumstances and the consequences each may have on a patient. We concluded that: better control of sympathetic nerve blockade and less adverse effects can be achieved with CSA, optimal management of thrombocytopenia should be done in a patient prior to regional anesthesia, and CSA is an anesthetic alternative to consider on elderly patients with an anterior mediastinal mass undergoing hip fracture surgery.

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La presente publicación condensa las interpretaciones de los autores entorno a la formación y conocimiento de valores políticos en la escuela, percepciones acerca de la democracia y ciudadanía. Es notable la semejanza que existe entre los alumnos y sus maestros y sus respectivas maneras de realcionarse con lo político, ambos grupos valoran positivamente la democracia y la asimilan sobre todo a valores de igualdad y libertad.

RESUMO

Este documento corresponde a una parte de los resultados obtenidos de las actividades del proyecto de Educación y Valores en la Escuela, específicamente de la formación de valores. En este ámbito, se ha podido detectar notables semejanzas entre los alumnos y sus maestros, ambos señalan como los valores mas importantes la fé y la solidaridad, en tanto que la belleza y el poder ocupan los últimos puestos en sus escala de valores, así mismo toca otros aspectos a los que ha llegado el proyecto.

Assuntos

Assuntos

Assuntos

RESUMO

La Cancha es un laberinto de calles, pasajes y galerias donde confluye una gama indespensable de comerciantes que ofrecen los más variados productos de diversas calidades, compradores de todas las clases sociales que demandan artículos para el consumo cotidiano, trabajadores ambulantes y cargadores o changadores. En un espacio donde se congrega toda la ciudadanía; donde se confunden las voces y los gritos de comerciantes y consumidores: "compráme, caseritay! te hey de dar yapado": "rebajarime pues!". Algunas vendedoras incansables, trasladan continuamente sus productos. Niños pequeños ofrecen agua a los comerciantes a cambio de alimentos. Es un ir y venir de amas de casa en busca de los articulos más baratos para el comsumo familiar: unas regatean precios, en tanto que otras ofrecen precios más altos para asi obtener productos de mejor calidad.

Assuntos