Laparoscopic diaphragmatic plication for paralysis posterior to trauma. Case report

Diaphragmatic paralysis is a pathology characterized by the elevation of a plastic and inactive atrophic diaphragm, followed by an injury to the spinal column or to the phrenic nerve. Because it involves the phrenic nerve, it is often associated with an injury at its exit in the spinal cord at the radicular level, at the conduct or in the peripheral nerve. Clinical case: A 50-year-old male patient with a history of thoracic trauma and diagnosis of unstable thorax is admitted for progressive dyspnea in the following 8 months. Diaphragmatic paralysis is diagnosed and a laparoscopic diaphragmatic plicature is performed. Patient improved his clinical status by 29%. Discussion: The consequences of the elevation of a hemidiaphragm can be respiratory, causing hypoxemia and decreases in the ventilation---perfusion ratio. This procedure is considered a corrective surgery from the morphological and functional point of view. Conclusions: Our patient’s clinical status improved according to the Saint George respiratory questionnaire, thanks to an improved perfusion of the basal lung expansion. Laparoscopic diaphragmatic plicature is a safe procedure associated with a minimal hospital stay, and more cases need to be reported. This is the procedure of choice in our institution

Self-inflicted wound with a nail in the heart: case report

Adequate diagnosis and treatment of penetrating cardiac injury (PCI) represents a great challenge for the surgeon in the emergency department (ED) because of its high mortality. It is estimated that more than 90% of mortality happens before the patient reaches the hospital and only 15---50% of those will receive appropriate medical treatment. Case report: A 42-year-old hemodynamically stable male is brought to the ED with a protruding nail in his thorax. He is taken to the operating room (OR) where a medial sternotomy is performed and an injury is found in the left ventricle. Cardiac muscle repair is performed with pericardial patch. Discussion: PCI from a suicide attempt secondary to a nail hammered into the chest is very rare and no previous reports were found by the author. Conclusion: The objects that penetrate cardiac structures must be removed in a proper OR with capable personnel and the resources available to perform procedures like an urgent thoracotomy or sternotomy

Emphysema model in rats exposed to tobacco smoke. Morphometric and functional analysis

Several models of chronic obstructive pulmonary disease (COPD) in mice have been developed; the most similar to the habit of smoking is the inhalation of the smoke in mice. The objective was to develop and implement an experimental model of COPD in mice through the passive inhalation of smoke and demonstrate the physiological changes on ventilatory function and its correlation with 3 emphysema quantification methods. Materials and methods: Twenty Wistar mice were included in an experimental and control group. The experimental group was exposed to tobacco smoke, and we performed several pulmonary functional tests and imaging techniques. Results: Pulmonary function tests showed the volume expiration in the first second (VEF1) differs significantly between groups (p < 0.001). Pulmonary compliance was reduced in the experimental group by 50% in comparison to the control group (male vs control p < 0.001). Morphometric analysis: 17% reduction in lung volume with a destructive index (DI) of 45%. The intersection test had a DI of 43%. The free point test showed a DI of 44%. Conclusions: The implementation of our model generated the presence of emphysema and alterations in the lung physiology in the experimental group. We demonstrated evidence of 90% with emphysem

Identificación de flora bacteriana en cultivos de bilis y pared de vesícula biliar de pacientes sometidos a colecistectomía laparoscópica en el Hospital Universitario «Dr. José Eleuterio González»

Antecedentes: Se ha aceptado a través del tiempo que la bilis en condiciones normales es estéril. La bactobilia es un hallazgo común en individuos de alto riesgo o con cuadros de colecistolitiasis complicados, sin embargo, hay pocos datos con respecto a la prevalencia de bactibilia en pacientes sometidos a colecistectomía por colecistolitiasis no complicada. Es común el uso de agentes antibióticos preoperatorios y postoperatorios en los diferentes pacientes que son sometidos a colecistectomía laparoscópica, sin que exista una base bacteriológica y epidemiológica demostrada sobre el predominio bacteriano determinado, su resistencia y sensibilidad en nuestro medio. Material y métodos: Pacientes con diagnóstico de colecistitis litiásica, a quienes se realizó CL con una muestra calculada por proporciones de 183 unidades (IC 95%). Resultados: Se identificó bactibilia en el 31.95% de los cultivos de colecistitis leve y en el 35.71% de los cultivos de pacientes con colecistitis moderada (p < 0.0001). Se recolectaron un total de 125 cultivos negativos (68.3%) y 58 positivos (31.69%) con un claro predominio del grupo de enterobacterias (43.10%) y Enterococcus (27.58%). Conclusiones: Comparando los grupos de acuerdo al grado de severidad, hay una diferencia significativa en relación a la presencia de bactibilia, así como en el tipo de agentes aislados. Las fluoroquinolonas asociadas a metronidazol son una opción de tratamiento en pacientes en los que se sospecha bactobilia. Actualmente no está justificado el uso de antibioticoterapia en pacientes de bajo riesgo. © 2016 Publicado por Masson Doyma M´exico S.A. en nombre de Academia Mexicana de Cirug´ıa A.C. Este es un art´ıculo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). ABSTRACT Background: Through experience it has been accepted that bile in normal conditions remainssterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecys-tolithiasis, however few data prevails about the prevalence of bactibilia in patients operatedon for uncomplicated laparoscopic cholecystectomy. There is s common usage of preopera-tive and postoperative antibiotics in the different patients without the existence of any actualbacteriologic and epidemiologic evidence.Material and methods:183 patients with diagnosis of cholecystolithiasis postoperated of lapa-roscopic cholecystectomy had their bile sent to bacteriology.Results: Bactibilia was identified in 31.95% of the cultures of mild cholecystitis and in 35.71%for moderate (p < .0001). A total of 125 negative cultures were obtained (68.3) and 58 positive(31.69%) with a prevalence of enterobacteria group (43.10%) and Enterococcus (27.58).Conclusions: Comparing the groups according to severity there is a significant difference withregard to the presence of bactibilia, in addition to the bacterial groups cultivated. Fluoroqui-nolones and metronidazole is an option for the treatment of patients with the suspicion ofbactibilia. The use of antibiotics is not justified in patients at low risk.© 2016 Published by Masson Doyma M´exico S.A. on behalf of Academia Mexicana de Cirug´ıa A.C.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)