Nutcracker syndrome: a review

Left renal vein (LRV) entrapment is an anatomic condition characterized by extrinsic compression of the renal vein and consequent impaired inferior vena cava (IVC) outflow. Nutcracker syndrome (NCS) can be caused by compression of the LRV between the aorta and the superior mesenteric artery or by compression of LRV between vertebral bodies and the aorta. The most common presentations in NS include pelvic or left flank pain, hematuria, gonadal varices, thus the hallmark manifestations of NCS may be related to renal venous congestion and increased pressure within the venous structures. Computed tomography, magnetic resonance imaging and doppler ultrasonography are reasonable imaging studies in patients with suspected NCS, but invasive evaluation with catheter venography and pressure measurement is often required to the definitive diagnosis. For now, it is not possible to standardize a treatment modality, although the trend towards endovascular management is clear; therapeutic strategies with open surgery should not be lost for those cases that correspond to this

Biological characterization of a biodegradable scaffold for common bile duct replacement in an experimental model

Background: The nanofiber scaffolds achieved by the electrospinning technique have been used to develop several biological tissues, the nanofibers obtained by electrospinning procure a favorable microenvironment to mimic the extracellular matrix. Methods: Study type was of experimental. Study conducted at National Autonomous University of Mexico, from May 2018- May 2022. The protocol was approved by the research and ethics commissions of the UNAM school of medicine. A viscoelastic solution of polylactic-co-glycolic acid (PLGA) and polycaprolactone (PCL) in a 70:30 ratio and gelatin (Gel) in an 80:20 ratio was prepared while a dynamic collector was used with the electrospinning technique. Results: Mechanical and biological tests were carried out on the scaffold obtained by electrospinning; the resultant scaffold achieves good mechanical matching and structural similarity between the graft and the extrahepatic bile duct. Conclusions: In this study we managed to create a porous, biocompatible scaffold with good cell adhesion and proliferation, potentially applicable to tissue engineering, especially for the replacement of tubular organs such as blood vessels, bile ducts, and urethra

Affordable laparoscopic simulator to acquire basic skills in undergraduate surgery students

Background: The simulation emerges as an option that allows students to practice in a safe environment, all this in a scenario that resembles the real situation.Methods: We developed a prototype of a low-cost simulator that mimics the dimensions of the abdominal cavity and allows the undergraduate students to acquire the basic skills in minimally invasive surgery.Results: In the 10 competencies evaluated, statistically significant improvement was found in both groups being higher in the students who were trained by our simulator of laparoscopic surgery compared with students who attended surgeries and participated as seconds assistants, taking as reference a value of p ≤0.05.Conclusions: The simulation as new teaching strategy generates a real environment and scenarios that can be recreated in multiple occasions, being able to change depending on the objectives for the acquisition of skills. This simulator gives the user skills for more types of simulation as it progresses in its surgical training

Neurophysiology of learning in basic skills of laparoscopic surgery in undergraduate students

Background: The development and progress in laparoscopic surgery requires greater emphasis on surgical skills, developing skills in undergraduate students allows them to be at the forefront in health demands.Methods: An experimental and descriptive study of a group of 30 undergraduate students of the Faculty of Medicine. They attended 30 hours of theoretical and practical sessions distributed by 10 sessions, supported by basic simulators minimally invasive, being evaluated by checklist. Their brain activity was monitored with an electroencephalography before and after the development of skills.Results: It was observed that the average necessary for the acquisition of skills is 5 sessions. The competition in which further progress was observed is video assistance. There is an increase in the activity of the prefrontal cortex on the electroencephalography.Conclusions: A series of neurophysiologic processes involved in learning of laparoscopic surgery are described. Laparoscopic skills development lies in keeping them updated on the teaching-learning, where the use of simulators is growing

Tubular electrospun scaffolds tested in vivo for tissue engineering

Tissue engineering has been widely used for its great variety of functions. It has been seen as a solution to satisfy the need for vascular substitutes like small diameter vessels, veins, and nerves. One of the most used methods is electrospinning, due to the fact that it allows the use of various polymers, sizes, mandrels and it can adjust the conditions to create personalized scaffolds. For the creation of scaffolds is fundamental to understand the advantages and disadvantages of each polymer, of this, will depend the biodegradability, biocompatibility, porosity, cellular adhesion, and cell proliferation as it is essential to mimic the extracellular matrix and provide structural support for the cells. The aim of this review was to investigate which materials are being used for the creation of tubular scaffolds by electrospinning. Here we selected only in vivo evaluation to demonstrate remodeling of the grafts into native-like tissues, in vitro evaluations had been excluded from this review. We analyze the conditions like speed, distance and voltage and the modifications like growth factors and combinations of natural and synthetic polymers that allow the authors to have a functional scaffold that will suit its purpose

Decerebration induced by surgical transection of cerebral ganglion of crayfish

Background: Since the neural structures of the crayfish brain closely resemble their equivalent in the mammals. This can be suggested by observing the similarity that exists in the brain divided by the surgical transection of the crayfish brain in which the protocerebrum remains attached to the first two cranial nerves, findings also described by Frederic Bremer in 1935 in cats with cerebral transection.Methods: Total 11 Adult male crayfish were trained to respond with defense reflex, the animals were placed in water at 0°C, remained without any movement, and subsequently through a small incision of 3 mm in diameter in the medial antero region and dorsal cephalothorax region, a surgical section of the cerebral ganglion was performed. Immediately after surgery, metal microelectrodes were implanted to collect the activity of the photoreceptors and visual fibers.Results: Once the defense reflex begins to recover in previously decerebrated crayfish, it means that it shows signs of reconnection. The isolated protocerebrum with the deutocerebrum olfactory lobe remain alive for several days and the neuronal connections were reestablished, as measured throughout the bilateral defense activity. The defense reflex was observed in all animals and then recovered after surgery.Conclusions: The crayfish is an excellent model to work the visual activity, all coding of visual information was suppressed in de-cerebrated crayfish. The recovery of the neural disconnection is observed from 40 days, where the defence reflex appears again before visual stimuli.

Surgical management of enchondroma with joint transfer: a case report

The enchondromas are the most common benign bone tumor in the hands, mainly in young patients and its treatment is surgical in most cases due to its possible complications avoided through different procedures such as joint transfer, which allows to maintain a good quality of life for the patient. We present the case of a 42-year-old woman who came to the clinic for blunt trauma in the right hand where she was incidentally diagnosed with enchondroma on the third finger of the proximal interphalangeal joint of the right hand. Articular transfer of the proximal interphalangeal joint was performed. Second toe on the right, at 6 weeks corroborates correct evolution with bone consolidation of the articular transfer grade III and donor zone grade II, without infection complications, the correct recovery of the extensor movement range of this joint improving so their state of life should be the main objective of these procedures

Acute pulmonary non-cardiogenic edema after extubation with laryngospasm: a case report

Acute pulmonary edema post extubation due to negative pressure with laryngospasm in the early postoperative period has been reported and may occur at any time during anesthesia. The usual treatment consists of respiratory support and diuretics. We present the clinical case of a 15-year-old patient who underwent laparoscopic appendectomy, who presented acute non-cardiogenic pulmonary edema in the postoperative period. This complication can be presented in any surgical patient intubated, so it is important to know the pathophysiological basis to be able to diagnose and treat this pathology

The deep inferior epigastric artery perforator flap: a review

Breast cancer is recognized worldwide as a major health problem among women due to its high incidence and high mortality and morbidity rates. Breast reconstruction is an approach of great value for those patients who underwent mastectomy, impacting their quality of life and psychological stress. The deep inferior epigastric artery perforator (DIEP) flap was described as the preferred graft for breast reconstruction with an autologous flap by surgeons because it represented a decrease in complications for the time and obtained better results. DIEP flap reconstruction requires microsurgical skills as well as continuous monitoring of the patient to identify and resolve possible associated complications.

May-Thurner syndrome: a review

May-Thurner syndrome (MTS) is an underdiagnosed entity and level of suspicious should be raised during evaluation of deep vein thrombosis (DVT) of the left lower limb, especially in women between the third and fifth decades of life. To correctly identify MTS, high clinical suspicion, and imaging studies such as phlebography, magnetic resonance imaging (MRI), computed tomography (CT), and intravascular ultrasound are required. In correct clinical context, CT/MRI venography can be used to facilitate early diagnosis and treatment that includes pharmaco-mechanical thrombolysis with angioplasty and stenting, both of which minimize late morbidity from post-thrombotic syndrome