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RESUMEN La hidatidosis es una parasitosis endémica en la Argentina. Los órganos más afectados son hígado y pulmón, pero la afectación esplénica única es infrecuente. El objetivo del trabajo es presentar 2 casos de hidatidosis esplénica única. Su diagnóstico presuntivo se realizó mediante el antecedente epidemiológico y los estudios por imágenes. Las serologías resultaron negativas en ambos casos. El tratamiento fue quirúrgico: se realizó esplenectomía laparoscópica total. Esta patología debe sospecharse en zonas endémicas ante la aparición de quistes esplénicos a pesar de presentar serologías negativas. La esplenectomía total evita la recidiva local y cavidades residuales; se prefiere el abordaje laparoscópico al disminuir la estadía hospitalaria y las complicaciones de la pared abdominal.
ABSTRACT Hydatid disease is an endemic parasitosis in Argentina. The liver and lungs are the organs more commonly affected, but isolated splenic involvement is rare. The aim of this study is to report two cases of isolated splenic hydatid disease. The diagnosis was suspected by epidemiology and imaging tests. The serologic tests were negative in both cases. Surgical management was decided and both patients underwent laparoscopic total splenectomy. This disease should be suspected in endemic areas in the presence of splenic cysts despite negative serologic tests. Total splenectomy prevents local recurrence and complications associated with the residual cavity. The laparoscopic approach is preferred as it results in a shorter length of hospital stay and fewer abdominal wall complications.
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BACKGROUND: This study aimed to evaluate the use of artificial intelligence (AI) to detect the critical view of safety during elective laparoscopic cholecystectomy. METHODS: This was a prospective, observational study evaluating the detection of the critical view of safety with an AI software in a consecutive series of elective laparoscopic cholecystectomies compared with the blinded evaluation of 3 surgeons. The program was created using the digital tools PyCharm (JetBrains), Google Colab Pro (https://colab.google/), and YOLOv8 (Ultralytics). RESULTS: A total of 40 consecutive elective laparoscopic cholecystectomies were included in the study. The program was able to detect the critical view of safety in all cases following the experts' blinded opinion. CONCLUSION: In this preliminary experience, an AI software was able to detect the critical view of safety in elective laparoscopic cholecystectomies. Its application during nonelective cases, in which the critical view of safety is harder to achieve, might warrant further studies.
Assuntos
Inteligência Artificial , Colecistectomia Laparoscópica , Procedimentos Cirúrgicos Eletivos , Segurança do Paciente , Humanos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Estudos Prospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Software , Adulto , IdosoRESUMO
Purpose: To describe the surgical outcomes of rhegmatogenous retinal detachments (RRDs) associated with giant retinal tears (GRTs) and define factors associated with primary anatomic failure. Methods: This retrospective consecutive study comprised primary GRT-RRD surgeries between 1999 and 2021 at a single institution. Exclusion criteria were a follow-up of less than 3 months and incomplete surgical data. Results: The series included 69 eyes (64 patients). Single-surgery anatomic success (SSAS) was achieved in 75% and final anatomic success (FAS) in 90%. The mean logMAR visual acuity improved from 1.5 ± 1.1 to 0.6 ± 0.9. Preoperative factors significantly associated with redetachment were proliferative vitreoretinopathy (PVR) (odds ratio [OR], 6.2; P < .01), hypotony (OR, 13.6; P < .01), and a 180-degree or larger GRT (OR, 3.3; P = .04). All cases were treated with pars plana vitrectomy (PPV) and perfluoro-N-octane (PFCL). Perfluoropropane (C3F8) was used in 59% and silicone oil in 41%; the redetachment rate was significantly lower in gas cases (15% vs 39%) (P = .02). An encircling band, placed in 84% eyes, had a tendency to reduce redetachment (22% vs 36%) (P = .32). Lensectomy was performed in 61% of phakic eyes, with no effect on redetachment (20% vs 21%) (P = .92). On multivariate analysis, PVR and hypotony were significantly associated with redetachment. Conclusions: PPV with PFCL achieved high SSAS and FAS rates. PVR and hypotony were the main preoperative factors associated with anatomic failure. In cases without PVR, C3F8 tamponade significantly increased SSAS. Encircling scleral buckling showed a nonsignificant tendency toward an increase in SSAS. Lensectomy had no effect on SSAS.
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RESUMEN Antecedentes : el íleo biliar es una complicación infrecuente de la litiasis vesicular, observada más comúnmente en mujeres añosas. Es causada por la migración, a través de una fístula bilioentérica, de un cálculo que produce la obstrucción del tránsito intestinal, que requiere tratamiento quirúrgico. Objetivo : describir las variables preoperatorias, intraoperatorias y posoperatorias de una serie de casos de íleo biliar y la incidencia de íleo biliar recurrente. Material y métodos: se realizó un estudio retrospectivo observacional de pacientes operados con abdomen agudo obstructivo por íleo biliar entre enero de 2009 y diciembre de 2021. Las variables estudiadas fueron: estudios por imágenes, comorbilidades, vías de abordaje quirúrgico, tipo de cirugía, morbimortalidad y recurrencia del íleo. Resultados : sobre 667 pacientes que ingresaron con obstrucción intestinal, 21 tenían íleo biliar (3,1%). El diagnóstico se realizó por tomografía en el 80% de los casos. El abordaje quirúrgico fue por laparotomía en 20 casos y 1 por laparoscopia convertida. La cirugía más utilizada fue la enterotomía con enterorrafia en 18 casos. El tratamiento de la obstrucción fue la cirugía inmediata, mientras que el de la fístula biliar fue diferido en la mayoría de las oportunidades, debido a que el riesgo de tratarla en el momento era muy elevado. La morbilidad fue del 38% y la recurrencia del íleo biliar 4,7%. No se registró mortalidad. Conclusión : el íleo biliar fue una patología infrecuente, que pudo ser correcta y oportunamente diagnosticada y tratada con cirugía, con una baja incidencia de íleo biliar recurrente.
ABSTRACT Background : Gallstone ileus is a rare complication of cholelithiasis and mainly affects elder women. It is caused by gallstone migration through a cholecystoenteric fistula producing bowel obstruction, with the need for surgical treatment. Objective : The aim of this work was to describe the preoperative, intraoperative and postoperative variables of a case series of gallstone ileus and the incidence of recurrent gallstone ileus. Material and methods : We conducted an observational and retrospective study of patients undergoing surgery due to acute bowel obstruction caused by gallstone ileus between January 2009 and December 2021. The variables analyzed were imaging tests, comorbidities, surgical approach, type of surgery, morbidity and mortality and recurrent ileus. Results : Of 667 patients admitted with bowel obstruction, 21 had gallstone ileus (3.1%). The diagnosis was made by computed tomography scan in 80% of the cases. The surgical approach was laparotomy in 20 cases and 1 patient undergoing laparoscopy required conversion. Enterotomy with enterorrhaphy was the most common procedure used in 18 cases. The obstruction was treated by immediate surgery, while the biliary fistula was deferred in most cases because the risk of immediate treatment was very high. Morbidity was 38% and recurrence of gallstone ileus 4.7%. No deaths were reported. Conclusion : Gallstone ileus was a rare condition that was correctly diagnosed and timely treated with surgery, with a low incidence of recurrent gallstone ileus.
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El síndrome de Bouveret es una causa infrecuente de íleo biliar, posee una elevada morbimortalidad. Se produce por la migración de un cálculo, generalmente de gran tamaño, hacia el tracto gastrointestinal a través de una fistula colecistoduodenal. El objetivo de esta carta científica es presentar un paciente con un estadio previo de la enfermedad donde la fistula se encuentra constituida, pero sin migración del cálculo, por lo que el diagnóstico oportuno tendría un impacto favorable en el tratamiento y pronóstico debido a que no se encuentra instaurado el cuadro obstructivo intestinal.
Bouveret's syndrome is a rare cause of biliary ileus, with a high morbimortality. It is caused by the migration of a stone, usually large, into the gastrointestinal tract through a cholecystoduodenal fistula. The objective of this scientific letter is to present a patient with a previous stage of the disease where the fistula is constituted, but without migration of the calculus, so that the timely diagnosis would have a favorable impact on the treatment and prognosis because the obstructive intestinal condition is not established.
A síndrome de Bouveret é uma causa rara de íleo biliar com uma morbilidade e mortalidade elevadas. É causada pela migração de uma pedra, geralmente grande, para o tracto gastrointestinal através de uma fístula colecystoduodenal. O objectivo desta carta científica é apresentar um doente com uma fase anterior da doença em que a fístula está presente, mas sem migração da pedra, para que o diagnóstico atempado tenha um impacto favorável no tratamento e prognóstico, uma vez que a condição obstrutiva instestinal não está estabelecida.
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Humanos , Feminino , Pessoa de Meia-Idade , Colecistite/cirurgia , Colecistite/diagnóstico por imagem , Fístula Biliar/cirurgia , Fístula Biliar/diagnóstico por imagem , Doença Crônica , Diagnóstico PrecoceRESUMO
Around the world many people loss a body member for many reasons, where advances of technology may be useful to help these people to improve the quality of their lives. Then, designing a technologically advanced prosthesis with natural movements is worthy for scientific, commercial, and social reasons. Thus, research of manufacturing, designing, and signal processing may lead up to a low-cost affordable prosthesis. This manuscript presents a low-cost design proposal for an electromyographic electronic system, which is characterized by a neural network based process. Moreover, a hand-type prosthesis is presented and controlled by using the processed electromyographic signals for a required particular use. For this purpose, the user performs several movements by using the healthy-hand to get some electromyographic signals. After that, the obtained signals are processed in a neural network based controller. Once an usable behavior is obtained, an exact replica of controlled motions are adapted for the other hand by using the designed prosthesis. The characterization process of bioelectrical signals was performed by training twenty characteristics obtained from the original raw signal in contrast with other papers in which seven characteristics have been tested on average. The proposed model reached a 95.2% computer test accuracy and 93% accuracy in a real environment experiment. The platform was tested via online and offline, where the best response was obtained in the online execution time.
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RESUMEN Antecedentes: la pandemia de COVID-19 alteró la formación de los residentes de cirugía, disminuyendo sus oportunidades de aprendizaje. La lectura y análisis de trabajos científicos a través de pódcast podrían ser una opción para atenuar ese problema. Objetivo: evaluar la aceptación por parte de los residentes de Cirugía del uso de pódcast como una nueva herramienta educativa. Material y métodos: estudio exploratorio, analítico y longitudinal, realizado desde mayo hasta diciembre de 2020. Cada semana, un residente fue el encargado de leer, analizar y confeccionar una presentación grabada en forma de pódcast sobre un artículo seleccionado por médicos de planta. Se evaluó la experiencia de los residentes mediante un cuestionario tipo Likert diseñado por los investigadores. Resultados: se realizaron 37 pódcast, que se reprodujeron 2091 veces. El 100% de los residentes informó que esta herramienta fomentó la discusión académica entre pares, el 88% que le generó preguntas de investigación y el 43% que lo inspiró a una revisión bibliográfica. Conclusión: la lectura y análisis de trabajos a través de pódcast es bien aceptada y puede ser una herramienta adicional para el aprendizaje en épocas atípicas.
ABSTRACT Background: COVID-19 pandemic altered the training of residents in surgery, reducing their opportunities to learn. Reading and analyzing scientific paper via podcasts could be an option to mitigate such problem. Objective: The aim of this study is to evaluate residents in surgery acceptance of the use of podcasts as a new educational tool. Material and methods: We conducted a longitudinal, analytical and exploratory study between May and December 2020. Each week, a resident was in charge of reading, analyzing and preparing a recorded presentation in the format of a podcast of an article selected by a staff physician. The residents' experience was assessed by means of a Likert-type questionnaire designed by the investigators. Results: A total of 37 podcasts were recorded with a total number of plays of 2091. All the residents reported that this tool encouraged the academic peer discussion, 88% responded that it generated research questions and 43% agreed that listening to the podcasts served as inspiration to perform a bibliographic search. Conclusion: Reading and analyzing scientific papers via podcasts is well accepted and could be an additional tool for learning in atypical times.
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Cirurgia Geral/educação , Webcast , COVID-19 , Percepção , Médicos/psicologia , Estudos Prospectivos , Educação a Distância , Internato e Residência , AprendizagemRESUMO
Una buena higiene requiere de un lugar estructuralmente placentero y la aplicación de las Buenas Practicas de manipulación (BPM). Identificar que ocurre con las BPM en un centro de elaboración de alimentos en La Habana después de una cuantiosa inversión y cuál es la opinión de los manipuladores es el propósito del trabajo. Se aplicó la guía de Evaluación Sanitaria de Hoteles, elaborada por el Ministerio de Salud Pública de Cuba determinándose los aspectos deficientes. Se encuestaron los manipuladores y se evaluó el control de las BPM. Se realizaron 2 inspecciones una inicial anterior a la reparación y una posterior, se comprobó que existió mejoría de las condiciones higiénico sanitario pero las deficiencias entrenamiento/procedimiento se mantenían en el segundo lugar lo que apunta a la falta de sensibilización de los manipuladores y la administración. Los trabajadores plantean varios factores como elementos desfavorables como la no exigencia y control, la inestabilidad de la dirección entre otros. Además realizaron propuestas como poner carteles para enfatizar conductas, reconocimiento al manipulador que cumple con las BPM, apoyo y exigencia administrativa. En este centro cuando se valoró el control de la dirección se comprobó que no era sistemático que existían pocas evidencias y no se había diseñado un plan de mejoras.(AU)
We think that a nice, shining place, which is attractive to us, assures the correct hygiene. It is indisputable that a good hygiene needs of a place structurally pleasant to our senses but that also it agree with the hygiene norms, if this exists an excellent base is created for the application of the good practices of manipulation. To identify what is happen in a center of food elaboration in Havana after a large investment and what the opinion about the manipulators is to increase the employment of the good practices of manipulation. Two examinations were realized an initial previous to the repair and a later one, it was proved that improvement of the conditions increase hygienic sanitarily but the shortcomings training / procedure were supported in the second place what points at the absence of sensitization of the manipulators and the administration. The workers raise several factors as unfavorable elements: as not demand and control, the instability of the direction between others. Also they realized proposals like putting cartels to emphasize conducts, stimulation of the out-standing manipulator, support and administrative demand. In this center when the control of the direction was valued it was proved that it was not systematical that few evidences existed and a progress plan had not been designed.(AU)
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Manipulação de Alimentos/economia , Boas Práticas de Manipulação , Abastecimento de AlimentosRESUMO
Una buena higiene requiere de un lugar estructuralmente placentero y la aplicación de las Buenas Practicas de manipulación (BPM). Identificar que ocurre con las BPM en un centro de elaboración de alimentos en La Habana después de una cuantiosa inversión y cuál es la opinión de los manipuladores es el propósito del trabajo. Se aplicó la guía de Evaluación Sanitaria de Hoteles, elaborada por el Ministerio de Salud Pública de Cuba determinándose los aspectos deficientes. Se encuestaron los manipuladores y se evaluó el control de las BPM. Se realizaron 2 inspecciones una inicial anterior a la reparación y una posterior, se comprobó que existió mejoría de las condiciones higiénico sanitario pero las deficiencias entrenamiento/procedimiento se mantenían en el segundo lugar lo que apunta a la falta de sensibilización de los manipuladores y la administración. Los trabajadores plantean varios factores como elementos desfavorables como la no exigencia y control, la inestabilidad de la dirección entre otros. Además realizaron propuestas como poner carteles para enfatizar conductas, reconocimiento al manipulador que cumple con las BPM, apoyo y exigencia administrativa. En este centro cuando se valoró el control de la dirección se comprobó que no era sistemático que existían pocas evidencias y no se había diseñado un plan de mejoras
We think that a nice, shining place, which is attractive to us, assures the correct hygiene. It is indisputable that a good hygiene needs of a place structurally pleasant to our senses but that also it agree with the hygiene norms, if this exists an excellent base is created for the application of the good practices of manipulation. To identify what is happen in a center of food elaboration in Havana after a large investment and what the opinion about the manipulators is to increase the employment of the good practices of manipulation. Two examinations were realized an initial previous to the repair and a later one, it was proved that improvement of the conditions increase hygienic sanitarily but the shortcomings training / procedure were supported in the second place what points at the absence of sensitization of the manipulators and the administration. The workers raise several factors as unfavorable elements: as not demand and control, the instability of the direction between others. Also they realized proposals like putting cartels to emphasize conducts, stimulation of the out-standing manipulator, support and administrative demand. In this center when the control of the direction was valued it was proved that it was not systematical that few evidences existed and a progress plan had not been designed
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Una buena higiene requiere de un lugar estructuralmente placentero y la aplicación de las Buenas Practicas de manipulación (BPM). Identificar que ocurre con las BPM en un centro de elaboración de alimentos en La Habana después de una cuantiosa inversión y cuál es la opinión de los manipuladores es el propósito del trabajo. Se aplicó la guía de Evaluación Sanitaria de Hoteles, elaborada por el Ministerio de Salud Pública de Cuba determinándose los aspectos deficientes. Se encuestaron los manipuladores y se evaluó el control de las BPM. Se realizaron 2 inspecciones una inicial anterior a la reparación y una posterior, se comprobó que existió mejoría de las condiciones higiénico sanitario pero las deficiencias entrenamiento/procedimiento se mantenían en el segundo lugar lo que apunta a la falta de sensibilización de los manipuladores y la administración. Los trabajadores plantean varios factores como elementos desfavorables como la no exigencia y control, la inestabilidad de la dirección entre otros. Además realizaron propuestas como poner carteles para enfatizar conductas, reconocimiento al manipulador que cumple con las BPM, apoyo y exigencia administrativa. En este centro cuando se valoró el control de la dirección se comprobó que no era sistemático que existían pocas evidencias y no se había diseñado un plan de mejoras.
We think that a nice, shining place, which is attractive to us, assures the correct hygiene. It is indisputable that a good hygiene needs of a place structurally pleasant to our senses but that also it agree with the hygiene norms, if this exists an excellent base is created for the application of the good practices of manipulation. To identify what is happen in a center of food elaboration in Havana after a large investment and what the opinion about the manipulators is to increase the employment of the good practices of manipulation. Two examinations were realized an initial previous to the repair and a later one, it was proved that improvement of the conditions increase hygienic sanitarily but the shortcomings training / procedure were supported in the second place what points at the absence of sensitization of the manipulators and the administration. The workers raise several factors as unfavorable elements: as not demand and control, the instability of the direction between others. Also they realized proposals like putting cartels to emphasize conducts, stimulation of the out-standing manipulator, support and administrative demand. In this center when the control of the direction was valued it was proved that it was not systematical that few evidences existed and a progress plan had not been designed.