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

Introduction: Persistent gas leak is the most common postoperative complication in thoracic surgery. Currently there are no studies with sufficient scientific evidence to establish a standard for the treatment of this complication.Objective: To offer an update of the predisposing factors of gas leak, as well as the treatment modalities that have emerged in recent years. Methods: A bibliographic review was carried out in MEDLINE (PubMed), SciELO databases, as well as in academic Google. Variables such as type of lung resection, surgical time, and postoperative complications were taken into account. The keywords in Spanish and English were used and a total of 44 articles published from 1998 to 2020 were selected.Discussion: Although this complication is generally considered mild, it can have 46% incidence, being associated with an extra time of the hospital stay, affecting health costs, as well as discomfort and morbidity for the patient. Depending on when it occurs and its location, the treatment will include different alternatives that range from conservative management, to different modalities of pleurodesis, endoscopic or surgical treatment.Conclusions: The resolution of this entity occurs in most patients through the use of a chest tube, while alternative strategies will be required for the rest. It is important for surgeons to know their form of prevention, as well as all the therapeutic options, for their proper use based on their criteria or experience.Keywords: gas leak; pleurodesis; bronchoscopy.

Introducción: El tratamiento quirúrgico laparoscópico es utilizado en pacientes con cáncer de endometrio, cérvicouterino en estadio temprano y en el estadiamiento quirúrgico del cáncer de ovario.Objetivo: Describir el comportamiento de la cirugía mínimamente invasiva en el cáncer ginecológico en pacientes del Instituto Nacional de Oncología y Radiobiología de Cuba.Métodos: Se realizó un estudio descriptivo, observacional y retrospectivo de todas las pacientes con cáncer ginecológico (n = 112) tratadas por cirugía laparoscópica, en el período comprendido desde marzo de 2018 hasta marzo de 2019 en el Instituto Nacional de Oncología y Radiobiología. Las variables estudiadas fueron edad, índice de masa corporal, diagnóstico, tipo histológico, entre otras.Resultados: El grupo etario predominante fue de 61 a 70 años. El diagnóstico más frecuente fue el adenocarcinoma de endometrio con el 54,46 %. El proceder quirúrgico más utilizado fue la histerectomía total con doble anexectomía. Con relación al índice de masa corporal, las obesas representaron un 40,17 %. El tiempo medio del acto operatorio fue de 96,3 minutos con un rango de 33 a 143 minutos y la estadía hospitalaria fue menor de 24 horas en el 98,21 % de las pacientes. No se presentaron complicaciones y en cuanto a la conversión quirúrgica se realizó en el 1,79 % de los casos.Conclusiones: La cirugía laparoscópica en pacientes con cáncer ginecológico constituye un procedimiento factible y una alternativa eficaz para pacientes con adenocarcinoma de endometrio, carcinoma de cérvix en etapa temprana y en el estadiamiento ovárico.

Introduction: Anal cancer is the one with the lowest incidence of the digestive tract, but in recent years it has slightly increased.Objective: To identify the results of the treatment used for anal cancer in the Coloproctology Service of Comandante Manuel Fajardo Surgical Clinical University Hospital.Methods: A descriptive and observational study was carried out with patients diagnosed and treated for anal cancer in the 2014-2019 period. Variables such as pathological history, risk factors, symptoms, stage of the disease, treatments, among others, were studied.Results: The mean age was 58.4 ± 14.7 years and 75.3% were women. 52.1% had pathological antecedents and the most frequent risk factor was age (> 50 years: 80.8%). The most usual location was in the anal canal and stages II and III. Bleeding appeared in 58.9% of the patients. Chemoradiation therapy (87.7%), local exeresis (17.8%) and abdominoperineal surgery (8.2%) were applied. Colostomy was performed in 14% of individuals; 72.6% were free of colostomy for more than one year. The colostomy-free time was 87.5%, with treatment of 5 years and more. 24.7% died, the disease progression was the cause of death in 55.6% of the diseased subjects, while the most frequent cause was liver metastasis.Conclusions: Chemoradiotherapy was the main treatment with which an acceptable survival rate was obtained in patients with anal cancer.Keywords: anal cancer; squamous cell carcinoma; chemoradiation therapy.

Introduction: The maxillofacial region is vulnerable to trauma. Tools are used to assess the severity of maxillofacial trauma.Objective: To characterize maxillofacial trauma and its severity in patients cared for at the maxillofacial surgery emergency department of General Calixto García University Hospital.Methods: A cross-sectional, descriptive and observational study was carried out in patients attending the maxillofacial surgery emergency department at General Calixto García University Hospital, from September 2018 to March 2021. The study universe was 57 patients. The facial injury severity scale was applied. The analyzed variables were age, sex, etiology, diagnoses, complementary examinations, severity of maxillofacial trauma, immediate therapeutic procedures.Results: Mandibular fracture prevailed as a diagnosis (66.7 %). The most frequent etiology was interpersonal violence (29.8 %). Mild severity of maxillofacial trauma predominated (71.9 %). Extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation (5.3 %) and suturing (64.9 %) were the most frequently used immediate therapeutic procedures.Conclusions: There is a prevalence of male patients and the age group 19 to 30 years. Mandibular fracture predominates as a diagnosis. The most frequently used complementary tests are computed tomography, complete blood count and coagulogram. Interpersonal violence prevails as an etiology. Mild severity of maxillofacial trauma prevails. The most commonly used immediate therapeutic procedures are extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation and suturing.

Introduction: Esophagectomy is one of the procedures with the highest postoperative morbidity in digestive cancer surgery.Objective: To describe the complications related to scheduled subtotal esophagectomy according to variables of interest.Methods: A descriptive and cross-sectional study was carried out in the General Surgery Services at Saturnino Lora and Juan Bruno Zayas hospitals in Santiago de Cuba, from 2010 to 2019. The population consisted of 81 patients, out of which a random sample of 68 patients undergoing elective subtotal esophagectomy for esophageal cancer was selected. The variables investigated were presence of postoperative complications and type of surgical technique used. In addition, they were classified in grades according to Clavien-Dindo.Results: All the patients were operated by open technique by programmed subtotal esophagectomy, the resection by the Ivor-Lewis technique was performed in 69.2%. For all the surgical techniques used, atelectasis (39.7%) prevailed as a postsurgical complication, and among the infectious complications, pneumonia prevailed in 30 patients (44.1%), while for non-infectious surgical complications, pneumothorax was mostly incidental for 25.0%. The highest number of complications was in Clavien-Dindo grade II.Conclusions: The presence of post-surgical complications of the disease is notable, corresponding to what is reflected in the medical literature. There was significant relationship between the presence of smoking, chronic obstructive pulmonary disease and thoracotomy with some of the complications found.Keywords: esophageal cancer; esophagectomy; complications.

Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone.Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy.Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery.Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis.

Introducción: La cirugía ortognática está especialmente indicada en casos complejos, donde los procedimientos conservadores fracasan o son insuficientes. El diagnóstico, planificación y tratamiento deben estar a cargo de un equipo multidisciplinario que trabaje en estrecha relación.Objetivo: Reportar el trabajo multidisciplinario en el tratamiento ortodóncico quirúrgico de una desarmonía dentomaxilofacial compleja.Presentación de caso: Paciente masculino, 19 años de edad, mestizo, clase III esquelética grave, hiperdivergente con mordida abierta y asimetría del tercio inferior, que recibió tratamiento prequirúrgico descompensador de ortodoncia. Se realizó cirugía ortognática bimaxilar con genioplastia de ascenso.Conclusiones: El tratamiento de las desarmonías dentomaxilofaciales es complejo y necesita la concurrencia de varias especialidades. Para la resolución del presente caso fue necesario el trabajo coordinado y simultáneo de especialistas de ortodoncia, prótesis dental, cirugía maxilofacial, periodoncia, psicología y otorrinolaringología. Se alcanzaron resultados estéticos y funcionales acorde a los objetivos del tratamiento propuestos y hubo estabilidad un año después de la cirugía.

Introducción: Los enjuagues bucales contribuyen a la inhibición de la formación de la placa bacteriana y, por tanto, pueden ayudar a mantener el pH salival cercano a neutro.Objetivo: Identificar cambios en el pH salival de pacientes portadores de aparatología ortodóncica fija, después del enjuague con una solución de Stevia rebaudiana Bertoni y un enjuague comercial de aceites esenciales.Métodos: Se realizó un experimento clínico con un diseño factorial mixto en pacientes portadores de aparatología ortodóncica fija. Una vez firmado el consentimiento informado, treinta y dos pacientes fueron asignados aleatoriamente a uno de 2 grupos: la solución de S. rebaudiana B. al 2 % o un enjuague comercial de aceites esenciales. Se utilizaron 15 ml de enjuague durante 60 s en todos los pacientes. El pH salival fue medido por dos observadores independientes calibrados, utilizando papel medidor de pH antes del enjuague (medición basal) y después del enjuague, a los 5 y 20 min. Los datos fueron analizados mediante el ANOVA mixto.Resultados: Se encontró una interacción estadísticamente significativa entre el tipo de tratamiento y el momento de medición del pH. Los pH medio de los grupos S. rebaudiana y aceites esenciales fueron respectivamente en la medición basal: 6,61 y 6,52 (p = 0,72); a los 5 min: 7,61 y 7,77 (p = 0,40); y a los 20 min: 7,72 y 6,82 (p < 0,001).Conclusiones: Ambos enjuagues tenían el efecto de aumentar el pH salival a niveles alcalinos a los 5 min, pero solo el enjuague de S. rebaudiana B. al 2 % mantuvo el pH básico a los 20 min.

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos.Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical.Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm.Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar).

Introduction: Few studies are available about common mental disorders and mental health-related quality of life among dental healthcare providers.Objective: Describe the common mental disorders and the mental health-related quality of life of members of oral health teams from the primary health care section of the Unified Health System in the Metropolitan Region of Salvador de Bahia, Brazil.Methods: A descriptive cross-sectional study was conducted based on the Symptom reporting questionnaire for the evaluation of common mental disorders, the Health questionnaire about health-related quality of life, and a sociodemographic characterization questionnaire.Results: The study sample was composed of 161 professionals, of whom 59.6% were dentists and 40.4% were dental auxiliaries. Dentists obtained a higher average score in the Symptom reporting questionnaire (p = 0.032), whereas their scores in the mental health domains of the Health questionnaire were lower and significant. Three factors in the Symptom reporting questionnaire exhibited a high negative correlation with the mental health domains of the Health questionnaire.Conclusions: Dentists presented greater symptoms of common mental disorders and mental health-related quality of life deterioration than dental auxiliaries. It is therefore necessary to implement mental health promotion strategies aimed at members of oral health teams.