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Objetivo: Dar a conocer un caso de cuerpo extraño (cuchillo) de 16 cm de longitud, asintomático por ocho años, alojado en el muslo, descubierto por casualidad en estudio radiográfico. Sede: Hospital de Tercer Nivel de Atención. Diseño: Informe de caso clínico. Descripción del caso: Paciente de 28 años de edad, ocho años atrás sufrió asalto con arma blanca mientras estaba montado en motocicleta, sintió el impacto de un golpe en el muslo, si bien en ese momento logró escapar en su vehículo. Acudió a un hospital donde lo revisaron clínicamente, sin toma de estudios de gabinete; suturaron la herida, cursó sin complicaciones y sin síntomas. Ocho años después se dio cuenta del cuerpo extraño porque le efectuaron placa de muslo por trauma leve. Conclusión: Los métodos de diagnóstico efectivos para detectar un cuerpo extraño son la radiografía simple, ultrasonografía, tomografía axial computada y resonancia magnética. La falla en la identificación puede ocasionar complicaciones al enfermo de tipo infeccioso o lesiones a otras estructuras anatómicas y pudiera ser causa de demandas legales.

Objective: To inform on the case of a foreign body (knife) of 16 cm in length, which remained lodged in the thigh aymptomatically for 8 years, discovered by chance in a radiographic study. Setting: Third Level Health Care Hospital. Design: Case report. Description of the case: A 28-year-old patient, who eight years before was attacked with a knife while mounting a motorcycle. He felt the stabbing in the thigh, but was able to escape from the site on his vehicle, and went to a hospital where he was explored clinically but without any cabinet studies, the wound was sutured and the patient coursed without complications nor symptoms. Eight years later, he became aware of the foreign body when he had an X-ray taken of the thigh due to a slight trauma. Conclusion: Effective diagnostic methods to detect a foreign body are simple radiography, ultrasonography, CAT and MR imaging. Failure in identification can cause complications in the patient, either infectious ones or injuries to other anatomic structures, and could be a cause for liability demands.

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BACKGROUND: The subdermal single-rod contraceptive implant is used by more than one million women worldwide. In México there are ~ 600,000 colocated implants. Cases of complex implant localization caused by a deep insertion procedure have been reported. CLINICAL CASES: Two clinical cases of implant with complex localization are presented. Case 1: we present a 21-year-old female. After the insertion procedure during the 12-, 24-, and 36-month revisions, the implant could not be located. Case 2: we present a 28-year-old female with subdermal single-rod contraceptive implant co-located in the external side of the left arm, partially palpable on the extreme distal area. Transverse cut of ultrasound showed the extreme distal area of the implant at 6 and 7 cm, respectively, at the site of insertion (scar). CONCLUSIONS: Due to simplicity and accessibility, ultrasound is the selected method for identifying deep nonpalpable implants.

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Objetivo: Conocer la utilidad de un sistema de terapia basado en presión negativa tópica, aplicado en la herida quirúrgica complicada. Sede: Servicio de Cirugía General, hospital de tercer nivel de atención. Diseño: Estudio piloto, prospectivo, longitudinal y descriptivo. Análisis estadístico: Medidas de tendencia central. Pacientes y métodos: Se presentan seis pacientes postoperados, con herida quirúrgica abierta, complicada. Todos con infección demostrada por cultivo y con salida de material purulento, tres pacientes con abdomen abierto por sepsis abdominal, uno con lesión torácica postraumática, uno con muñón de amputación supracondílea infectado y el último paciente con herida quirúrgica complicada posterior a dermolipectomía; todos ellos con tratamientos previos sobre la herida quirúrgica antes de aplicar la presión negativa. Se incluyeron pacientes consecutivos que presentaban: herida complicada, infectada, con estancia hospitalaria prolongada, quienes no presentaban progreso con el tratamiento médico tradicional. Resultados: El tiempo de aplicación de la presión negativa para los seis pacientes estuvo entre 6 y 26 días, con evolución satisfactoria, obteniéndose la mejoría deseada de la herida quirúrgica y de la cavidad abdominal. En los tres pacientes con abdomen abierto y tratamiento previo con bolsa de Bogotá, se pudo cerrar la cavidad abdominal entre los 14 y los 26 días posteriores al tratamiento con presión negativa; en los otros tres pacientes, con lesiones más superficiales, el cierre de la herida se logró entre el sexto y el décimo cuarto día. En todos hubo seguimiento mayor a cinco meses, conservándose la herida cerrada, sin alteraciones. Conclusión: La terapia de presión negativa fue útil en el tratamiento de pacientes con heridas quirúrgicas complicadas y/o en el tratamiento de pacientes con abdomen abierto en sustitución de la bolsa de Bogotá. Del 100% de días de estancia hospitalaria, el 30% fue con terapia basado en presión negativa tópica.

Objective: To know the usefulness of a therapy system based on negative pressure topically applied on a complicated surgical wound. Setting: General Surgery Service, third level health care hospital. Design: Pilot study, prospective, longitudinal and descriptive. Statistical analysis: Central tendency measures. Patients and methods: We present six post-operated patients with open complicated surgical wounds. All with infection demonstrated by culture and output of purulent material: three patients with open abdomen due to abdominal sepsis, one with post-traumatic thoracic injury, one with an supracondyle infected stump, and the last with complicated surgical wound due to dermolipectomy, all of them with treatments of the surgical wound before applying negative pressure. We included consecutive patients coursing with complicated infected wounds, prolonged in-hospital stay, and who did not improve with traditional medical treatment. Results: The time of negative pressure application for the six patients ranged from 6 to 26 days, with satisfactory evolution, obtaining the expected improvement of the surgical wound and the abdominal cavity. In the three patients with open abdomen and previous treatment with Bogota pouch, the abdominal cavity could be closed between 14 and 26 days of negative pressure treatment; in the other three patients with more superficial wounds, closure of the wound was achieved between the 6th and 14th day. All patients were followed for more than 5 months, the wound remained closed and without any alterations. Conclusion: Negative pressure therapy was useful in the treatment of patients with complicated surgical wounds and/or treatment of open abdomen substituting the Bogota pouch. Of the 100% of in-hospital stay days, 30% corresponded to topically applied negative pressure therapy.

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BACKGROUND: One hundred percent of the cases of familial adenomatous polyposis (FAP) will develop carcinoma; therefore, the necessity of diagnosis at an early age with immediate therapy is essential. In the presence of identical twins, it is mandatory for both to undergo comprehensive colonic examination as early as possible. The study took place at a third-level general hospital with the objective of explaining in detail the importance of early diagnosis of FAP. CLINICAL CASES: We report on FAP in identical male twins who were operated on at different times with different outcomes and prognosis. The first twin was treated 20 years previously at an early age and underwent subtotal colectomy with ileoproctostomy. This patient is currently asymptomatic with no evidence of malignancy. The second twin was operated on at the age of 33 years and was already a carrier of a well differentiated rectal adenocarcinoma. CONCLUSIONS: Opportune therapy carried out on the first twin has resulted in a disease-free status, in contrast with the delay in treatment of the second twin who developed carcinoma.

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BACKGROUND: One hundred percent of the cases of familial adenomatous polyposis (FAP) will develop carcinoma; therefore, the necessity of diagnosis at an early age with immediate therapy is essential. In the presence of identical twins, it is mandatory for both to undergo comprehensive colonic examination as early as possible. The study took place at a third-level general hospital with the objective of explaining in detail the importance of early diagnosis of FAP. CLINICAL CASES: We report on FAP in identical male twins who were operated on at different times with different outcomes and prognosis. The first twin was treated 20 years previously at an early age and underwent subtotal colectomy with ileoproctostomy. This patient is currently asymptomatic with no evidence of malignancy. The second twin was operated on at the age of 33 years and was already a carrier of a well differentiated rectal adenocarcinoma. CONCLUSIONS: Opportune therapy carried out on the first twin has resulted in a disease-free status, in contrast with the delay in treatment of the second twin who developed carcinoma.

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OBJECTIVE: We proposed a modification of thyroid surgery and have reported two operations carried out with sutureless surgery and local anesthesia. Our study setting was Unit 305 of the General Hospital of Mexico in Mexico City. With regard to study design, two patients are presented with sutureless thyroid surgery in what we believe is the first publication of its kind in Mexico and probably the first publication in the world that reports the combination of both sutureless technique and local anesthesia. MATERIAL AND METHODS: Patient number 1 is 41 years of age with a 10-year history. Fine-needle biopsy denoted nodular goiter but definitive diagnosis was Hashimoto thyroiditis, for which we performed subtotal resection. Patient number 2 is 46 years of age, and has a history of 1 year of thyroid mass; final diagnosis was colloid goiter. Lobectomy and isthmus resection was done. We proceeded under local anesthesia plus sedation with the patient conscious, in combination with no stitches for hemostasia using a tissue-sealing system ligasure. RESULTS: Both patients had good results without postoperative complications. Surgical time was 120 min in first case and 71 min for the second. Patient 1 had transient hoarseness for 3 weeks, and the healing was spontaneous. CONCLUSION: Outcome was adequate in these two cases with local anesthesia and no stitches.

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Today, these exist worldwide organizations related with the practice of medicine that are interested in marking recommendations and in formulating guidelines for better performance of physicians and health professionals. These organizations are headed by universities, associations, colleges, research center, and work groups and are made up of well-known physicians with academic prestige from the private and public sectors. This report presents a brief overview concerning the development of three clinical guides related with illnesses frequently observed in the physician's office: rhinosinusitis gastroesophageal reflux diseases (GERD), and prostate benign hyperplasia. These guides are issued by one of the most important academic institutions in the country. In the above-mentioned works, the efforts of specialist who are opinion leaders in these topics form different states of the country converge. Likewise, critical points to consider for producing clinical guides are provided mechanisms of diffusion, consultation, feedback and updating of these documents, have already been provided and focus on national medical practice quality of services, and the manner in which to carry out diagnosis and therapy at the different levels of medical care, with emphasis on preventing complications.

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BACKGROUND: At present, utilization of mesh is best option for surgical groin hernia treatment. Affirmation must be corroborated in hernia clinics of a national concentration hospital to ascertain which is the most recommendable with regard to technique therapeutics and economic factors. PLACE: A tertiary level concentration general hospital. MATERIAL: There were 61 groin hernia repairs in 59 patients, 54 males 91.5% and five females (8.5%). Average 43 age was, minimum 17, maximum 81, median 41 mode 55 years. Plain mesh of expanded polytetrafluoroethylene was used. METHODS: A prospective, descriptive, and longitudinal study was conducted in a 1-year. Inclusion criteria included patients who accepted the mesh proceeding and bought the mesh. We made a date gathering sheet with age, gender, hospital stay, surgical time, pain scale and complications. Patients underwent follow-up at 7, 14, 21, and 30 days after each month. RESULTS: Average surgical time was 53 min average hospital stay 52 h. Five patients had complications, urine retention was present in two, and serosity in one there was case of rejection of surgical absorbable suture not related with mesh. There was no prolonged hospital stay, and no relapses. Pain measurement was performed at two different times; Average pain index was 3.76 for first and 2.48 for second on a 1-10 scale. On average, there were two doses of analgesics per patient. In this group, surgery was well accepted without severe complications and with low scale of pain.

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