Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introducción: La administración de bifosfonatos y medicamentos antiangiogénicos en pacientes con cáncer es un esquema terapéutico usual en oncología. Existen reportes de osteonecrosis de los maxilares en pacientes sometidos a este esquema de tratamiento, luego de realizar un procedimiento dental invasivo.Objetivo: A partir de las características clínicas e imagenológicas de la patología, ilustrar al odontólogo sobre los medicamentos para el tratamiento del cáncer, susceptibles de generar osteonecrosis de los maxilares.Presentación de caso: Paciente masculino de 89 años, con cáncer de próstata tratado con denosumab, que desarrolló osteonecrosis del maxilar inferior posterior a una extracción dental. Es de vital importancia que el odontólogo identifique los medicamentos, factores de riesgo y las medidas para minimizar el riesgo de osteonecrosis de los maxilares en pacientes susceptibles. 

La violencia laboral en el sector salud, es un problema que sigue estando presente en los centros de atención de salud en Costa Rica; la necesidad de que los usuarios de estos servicios y los profesionales conozcan más acerca del tema sigue estando presente, igualmente la prevención de la misma, tanto por parte del profesional como del usuario del servicio de salud. Objetivo general: Conocer la opinión de los pacientes que acuden a la consulta de la Facultad de Odontología de la Universidad de Costa Rica, con respecto a la violencia en los servicios de salud en general. Metodología: Se eligen al azar y se entrevistan 69 pacientes de la Facultad de Odontología por medio de una encuesta de 10 preguntas. Resultados: Se evidencian los actos de violencia en los servicios de salud de manera muy frecuente, siendo la violencia psicológica la más comúnmente encontrada. Conclusiones: A pesar de que los usuarios son conscientes de las formas de violencia y la frecuencia con que se presentan en los servicios de salud, no toman medidas para denunciar dichas acciones o mejorar los servicios. Recomendaciones: Capacitar al personal en salud, instruir e informar a los usuarios de los servicios de salud sobre sus derechos y deberes, e investigar más a fondo sobre este tema a nivel nacional.

Las lesiones genitales asociadas a violación sexual se clasifican según tipo de lesión, localización de la lesión y según sexo o edad de la víctima. La valoración clínica de estas lesiones representa un problema tanto medico como legal ya que no hay hallazgos patognomónicos de abuso sexual en la exploración, y la ausencia de signos no descarta el abuso o violación. Para el desarrollo de esta investigación se realizó una extensa revisión bibliográfica de artículos indexados publicados entre el 2000 y el 2017. La teoría establece que la población más susceptible a abuso sexual son las mujeres adultas y los pacientes pediátricos, con presentación de lesiones a nivel genital, anal y extragenital. Las lesiones genitales en población pediátrica se presentan frecuentemente en himen y labios menores, mientras que en mujeres adultas se presentan en fourchette posterior, labios menores e himen. Las lesiones genitales en hombres adultos son poco reportadas y su incidencia real se desconoce. Los tipos de lesiones más reportados son: desgarro, equimosis, abrasión, enrojecimiento e inflamación. La exploración y documentación de las lesiones genitales se beneficia de herramientas clínicas como inspección, colposcopía y aplicación de medios de contraste; así como de la aplicación de escalas de severidad de lesiones como la GISS.

Introduction: Closure with massive loss of abdominal wall tissue is a challenge in surgery.Objective: To report a case of difficult abdominal closure where the Bogotá bag technique was used until the approximation of the cutaneous, muscular and aponeurotic planes was achieved.Clinical case report: This patient was received in the emergency room with a perforating-cutting wound in the left lumbar fossa. In the intervention, hemoperitoneum was found due to splenic and diaphragmatic injury and section of the splenic flexure of the colon. Splenectomy, left pleurostomy and colonic injury raffia were performed. After five hours, the patient was operated again due to signs of shock. We found a retroperitoneal hematoma and a complete section of the upper pole of the left kidney. It was decided to perform left nephrectomy. On the fifth postoperative day, this patient showed peritoneal signs and examination confirmed fecal peritonitis due to dehiscence of the colon suture. Cavity was washed and a Devine-type colostomy was performed. The massive loss of the abdominal wall made it necessary to use a plication of the Bogotá bag to approximate both flaps, a gradual approximation was obtained until the synthesis of the wall.Conclusions: The catastrophic abdomen is a serious condition that is difficult to treat. The Bogotá bag is a viable alternative for this condition and modified with gradual plications, it allows the two skin flaps to approach each other and guarantees the closure of the abdominal wall, in addition to being an easy-to-use and economical technique.Keywords: open abdomen; Bogota Stock Exchange; surgery.

Introduction: Ascaris lumbricoides is the most frequent helminthiasis in the human gastrointestinal tract; the highest prevalence is recorded in developing, tropical and subtropical countries. In Cuba, it constitutes an exotic cause of obstructive jaundice with few reported cases.Objective: To describe the successful therapeutic management of a case of a man with obstructive jaundice secondary to choledochal ascariasis.Clinical case report: We report the case of a 74-year-old patient operated on at Lucía Íñiguez Landín Surgical Clinical Hospital, in Holguín province, for obstructive jaundice due to choledochal ascariasis, with satisfactory clinical-surgical evolution.Conclusions: In developing countries, ascariasis should be taken into account as a cause of biliary or pancreatic obstructive disease. Knowledge of the clinical condition and its complications, in addition to the different treatment options, should be the domain of every physician. Obstructive jaundice due to ascaris lumbricoides constitutes an exotic cause of this parasite infestation in Cuba.Keywords: obstructive jaundice; ascaris lumbricoides; common bile duct.

Introduction: Tracheocutaneous fistula is the most frequent complication of tracheostomy, leading to the need to use different types of plasties to achieve a definitive closure.Objective: To show a surgical treatment option for guaranteeing a definitive closure of recurrent tracheocutaneous fistula.Clinical case: We present the case of a 45-year-old male patient with a history of tracheostomy without spontaneous closure, who developed tracheocutaneous fistula managed through double plasty of anterior sliding of Szymanowski type, followed by recurrence. Direct closure of the tracheal mucosa was performed with platysma muscle plication and advancement of rectangular skin flaps for reinforcing coverage of the anterior wall of the trachea. Correction of the fistula was achieved by a simple, fast and effective procedure.Conclusions: This method avoids the difficulties found in other procedures, and guarantees functional and aesthetic correction with the use of a simple technique with low morbidity.

Introduction: Catastrophic abdomen or hostile abdomen is a surgical entity of great significance due to the loss of the different spaces between organs and the structures of the abdominal cavity. These alterations produce major anatomical changes due to a severe adhesive syndrome.Objective: To show the presentation of a catastrophic abdomen following gallstone ileus management in an adult patient.Clinical case: A 43-year-old male patient who, as a consequence of an acute obstructive abdomen due to gallstone ileus, had a torpid evolution into another care facility. Three surgical interventions were performed before he arrived at our care facility, where he was treated in a multidisciplinary and comprehensive way. He was hospitalized for 120 days and underwent five surgical interventions for application and replacement of the open abdomen negative pressure therapy (ABThera). During the last intervention, upon finding a clean cavity without leaks, a Roux-en-Y gastroenteric anastomosis was performed, with a good clinical-surgical evolution until discharge and follow-up of two months thereafter in the outpatient clinic.Conclusions: Catastrophic abdomen is a challenge to be managed by surgeons because it requires, apart from vast knowledge, the support of other specialties to combat this entity.

Introduction: Littré's hernia is defined as the presence of a Meckel's diverticulum in any hernial orifice. Very few cases have been reported in the literature because of its very low frequency, referred to as of 2% of the general population.Objective: To report and share the successful management of a rare clinical case of mechanical intestinal occlusion due to Littré's hernia.Clinical case: This is the case of a 69-year-old white male patient with a history of arterial hypertension for seven years, for which he has been receiving regular treatment with captopril. He went to the general surgery emergency department of Lucía Íñiguez Landín Clinical Surgical Teaching Hospital for presenting diffusely localized colicky abdominal pain, of moderate intensity, without precise irradiation and accompanied by two small amounts of bilious vomiting, in addition to stopping gas and stool emission two days earlier, for which he was admitted for urgent surgical treatment with a diagnosis of mechanical intestinal occlusion.Conclusions: The preoperative diagnosis of Littré's hernia is unlikely, especially if accompanied by intestinal occlusion, a reason why it is almost always transoperative. The surgical treatment of the diverticulum depends on the inflammatory and vascular status.

Introduction: Endoscopic transanal microsurgery is a minimally invasive procedure for local treatment of large adenomas and early-stage rectal cancers.Objective: To assess the outcomes of endoscopic transanal microsurgery in patients with benign rectal tumors at the National Center for Minimal Access Surgery in Havana.Methods: A retrospective study of a 15-year prospective database was carried out. A total of 91 patients with benign rectal tumors underwent endoscopic transanal microsurgery between April 2004 and December 2019. The following variables were included: age, sex, indication, surgical time, tumor location, tumor size, hospital stay, postoperative complications and local recurrence.Results: The main indication was rectal adenoma, accounting for 70 (76.9%) patients. The mean age was 63.4 years, surgical time was 81.1 minutes and tumor size was 3.5 cm. Hospital stay was one day. Postoperative complications were four (4.3%): two bleedings, one suture dehiscence and one stenosis. Two patients (2.8%) had local recurrence in the adenoma group. No conversions to laparoscopic or open surgery were performed.Conclusion: Endoscopic transanal microsurgery was a feasible and safe technique in the treatment of endoscopically unresectable rectal adenomas, adenomas with high-grade dysplasia and other rectal tumors.

Introducción: Los cuidados perioperatorios estandarizados ayudan a asegurar que todos los pacientes reciban un tratamiento óptimo.Objetivo: Aplicar un método de cuidados perioperatorios multimodales sistemáticos, en pacientes sometidos a cirugía pulmonar mayor.Métodos: Se realizó una revisión narrativa de la literatura relevante, publicada sobre el tema en las bases de datos MEDLINE, Cochrane, además de Medigraph, en idiomas inglés, español y francés. Se hizo énfasis en los artículos de los últimos 5 años, sobre todo estudios aleatorizados, bases de datos institucionales y nacionales, revisiones sistemáticas, metanálisis y programas y protocolos ERAS/ERATS, además de artículos de revisión.Desarrollo: Los estudios obtenidos fueron evaluados por los autores por separado y, más tarde, en conjunto para definir cuáles se ajustaban a los objetivos. El protocolo se dividió en 5 fases: preoperatoria, ingreso hospitalario, preoperatoria inmediata, intraoperatoria, posoperatoria. Para cada una de ellas se definieron las acciones a realizar, según la evidencia disponible.Conclusiones: La implantación del protocolo permitirá pasar de una fase empírica a una investigativa, de manera que se podrán obtener resultados superiores en el tratamiento quirúrgico de los pacientes enrolados en las investigaciones que se realicen.