Cirugia y cirujanos (CIR CIR )

Publisher: Academia Mexicana de Cirugía


Publicación del Academia Mexicana de Cirugía. Misión: Publicar artículos relacionados con la cirugía o con ramas afines bajo la forma de editoriales, artículos originales, artículos de revisión, casos clínicos, de información general y cartas al editor.

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Publications in this journal

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    [show abstract] [hide abstract]
    ABSTRACT: Solid pseudopapillary tumor of the pancreas is an epithelial tumor of low malignancy that primarily affects young women and represents approximately 1-2% of all pancreatic neoplasms. We present a case of this type of tumor treated in the General Hospital of Tijuana, Mexico, as well as a review of the literature. We present the case of a 37-year-old female with symptomatology of early satiety and abdominal distension. During open cholecystectomy we found a tumor in the body of the pancreas. Biopsy was done, establishing the diagnosis of solid pseudopapillary tumor of the pancreas. The patient was treated successfully with distal pancreatectomy and splenectomy. Solid pseudopapillary tumor of the pancreas is a rare neoplasm. It is more frequent in young women and has an unknown etiology. Clinical manifestations include abdominal pain, sensation of plenitude or early satiety, abdominal mass, nausea and vomiting. Laboratory tests are usually normal. Computerized axial tomography may show a large encapsulated heterogeneous mass. Diagnosis is established through biopsy and surgery is the best treatment for this pathological entity. One may conclude that the solid pseudopapillary tumor is a differential diagnosis in the presence of pancreatic tumors, although due to its rarity it is not the first option to discard. Surgery represents the best treatment for this pathological entity and should be attempted in all cases, independent of the size of the pancreatic injury.
    Cirugia y cirujanos 06/2013; 78(1):73-8.
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    ABSTRACT: introduction: Acetylcholine is an essential neurotransmitter in the central nervous system as it has an effect on sleep, memory and learning. Intracerebral microdialysis is an in vivo surgical technique that is used to measure the concentration of substances in the extracellular space. Methods: The rats were stereotaxically implanted with microdialysis cannulae guided to the hypothalamic medial preoptic area and bipolar stainless steel electrodes to obtain sleep records simultaneously with microdialysis samplings during 24 hours exposed to clean air followed by 24 hours of exposure to ozone. Microdialysis fractions were injected into chromatograph system. Results: Results showed that paradoxical sleep and wakefulness decreased by 54.2% and 27.9%, respectively, while slow wave sleep increased by 35.1% during the ozone exposure phase and a concomitant decrease of extracellular acetylcholine of 56.2% was observed during the light-dark phase. Conclusion: That surgical method employed using electroencephalography and intracerebral microdialysis allows the quantification of extracellular acetylcholine and simultaneously with patterns related to sleep. We propose that the decrease in paradoxical sleep is the behavioral expression of disruptions of cholinergic modulation and, that post-exposure effects observed in the hypothalamic medial preoptic area can be explained on the basis of the hypothalamic role in the sleep-wake cycle.
    Cirugia y cirujanos 01/2013; 81(1):21-7.
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    ABSTRACT: introduction: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. Clinical case: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. Conclusions: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.
    Cirugia y cirujanos 01/2013; 81(1):60-3.
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    ABSTRACT: Introduction: Hand infections secondary to human bites often leave serious consequences on the functioning of the hand. Such infections are caused by different bacteria. Most bacteriological studies have been made to people of Anglo-Saxon origin or descent, and based on these findings; provide treatment to patients of different origins which may not always be as effective. Methods: Descriptive, internal stratified 17 patients were isolated samples of oral cavity and dental plaque bacterial species to identify and define the possible treatment according to the species identified. Results: Microorganisms were isolated Gram (+) and Gram (-) belonging to the normal flora of the oral cavity and dental plaque in all the cases studied, presenting a variable number of microorganisms according to age but not by sex. The group of Gram-positive bacteria isolated showed sensitivity to: erythromycin, chloramphenicol and ciprofloxacin. In the group of Gram negative: kanamycin, amoxicillin + clavulanic acid, ciprofloxacin and norfloxacin, E. Corrodens sensitive to the group of quinolones as ciprofloxacin, norfloxacin as well as ceftriaxone and cefoperazone sulbactam. Conclusions: The bacterial species that are commonly found in normal flora of the oral cavity and dental plaque may be potential pathogens in a hand injury where to find the appropriate conditions for their development.
    Cirugia y cirujanos 01/2013; 81(1):41-7.
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    ABSTRACT: Introduction: The distal radioulnar joint is of paramount importance for the proper function of the upper extremity. There is a wide variety of procedures for the treatment of its advanced pathology but none of them is capable of providing a stable load-bearing joint. Clinical case: We present the case of a 54 year old man who was treated by a semiconstrained bipolar distal radioulnar joint arthroplasty (Aptis) who had a distal radioulnar impingement secondary to a distal ulnar resection (Darrach) previously performed to treat a fracture-dislocation of the distal radioulnar joint. Conclusion: This case was the first semiconstrained bipolar distal radioulnar joint arthroplasty (Aptis) performed in México. This treatment is capable of providing provides a stable load-bearing joint.
    Cirugia y cirujanos 01/2013; 81(1):55-9.
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    ABSTRACT: Platelet-rich plasma is a blood product concentrate obtained by centrifugation of whole blood that is characterized by a high concentration of platelets (4 to 6 times their normal values). The high concentration of trophic factors contained in the granules of platelets, have led to suggest that the application of plateletrich plasma can help to stimulate or accelerate the repair or regeneration of a number of tissues. Since their first application in the treatment of skin ulcers in 1980, a considerable number of novel applications in different fields of medicine have emerged (Ophthalmology, Otorhinolaryngology, Maxillofacial Surgery surgical wounds, musculoskeletal disorders, burns, Esthetic Surgery, repair of peripheral nerves, etc.), some of these applications with clearly positive or very promising results. Despite the large amount of experimental and clinical literature about the usefulness of platelet-rich plasma in different areas of regenerative medicine, there are few therapeutic indications in which it is fully demonstrated its effectiveness. This fact highlights the importance of carry out methodologically appropriate clinical trials in the near future, in order to improve the evidence level of platelet-rich plasma treatment. The purpose of this article is to perform an update and critical review about the biological basis of platelet-rich plasma, to review indications for which there is more scientific support on its use, and finally to describe their new indications that are currently under research.
    Cirugia y cirujanos 01/2013; 81(1):74-82.
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    ABSTRACT: Introduction: Synovial cyst is composed by a fibrous wall; lining by a thin layer of synovial cells containing synovial fluid, the prototype of these, in the knee is the Baker's cyst, which is located abnormally in the gastrocnemius semimembranous bursa. Baker's cyst prevalence ranges from 5 - 38%. Clinical diagnosis is supported by the presence of increased volume of soft tissues located in the popliteal region. Clinical case: A 74 year-old woman with longstanding active rheumatoid arthritis who developed a large, recurrent Baker's cyst. The Baker's cyst had two flare-ups of pain and soft tissue swelling which eventually limited knee movements; was treated with needle aspiration guided by ultrasound and synovectomy with methotrexate twice. At 18-months follow-up, the patient remains without evidence of recurrence. Conclusions: Local infiltration of methotrexate represents an alternative therapy for those refractory Baker's cyst with partial response to conventional treatment, where the surgical procedure carries a high risk.
    Cirugia y cirujanos 01/2013; 81(1):64-8.
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    ABSTRACT: This paper aims to discuss and analyze the role of mathematics in neurodevelopment, for which discusses the historical, ontogenetic and physiological bases involved. The methodology of this paper is a deductive analysis, describing the use of mathematics in ancient cultures to the specialization of brain regions. Sensory perceptions are useful for the acquisition and development of cortical functions thus sensory stimulations is essential for the maturation of specialized neurologic functions.
    Cirugia y cirujanos 01/2013; 81(1):69-73.
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    ABSTRACT: introduction: It has been proposed that noradrenaline is one of the neurotransmitters involved in the functional recovery. In this sense, it has been proposed that the alpha-2 noradrenergic receptors play an important role in the functional reinstatement. Objective: the aim of this work was to study the role of the alpha-2 noradrenergic receptors on the noradrenaline contents in cerebellum and pons of rats iron-injured in the motor cortex. Methods: Fifteen male Wistar rats were allocated in three groups: control (n = 5) with intracortical infusion of saline (0.9%), injured (n = 5) with intracortical infusion of dextran iron and intraventricular infusion of saline, and injured + yohimbine (alpha-2 receptor antagonist; n = 5) that received an intracortical infusion of dextran iron and also an intraventricular infusion of yohimbine. Motor behavior was assessed by means of the beam-walking paradigm. Three days after surgeries, the animals were sacrificed and the left and right sides of the pons and the cerebellar hemispheres were extracted. Tissues were prepared for noradrenaline analysis by means of high performance liquid chromatography. Results: We observed that the yohimbine-treated animals had a noradrenaline increase in the right side of the pons and a decrease in the right cerebellar hemisphere. Conclusion: It is concluded that the blockage of the alpha-2 receptors leads to an increase of noradrenaline in the locus coeruleus, which retards the effects of the cerebral injury.
    Cirugia y cirujanos 01/2013; 81(1):28-32.
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    ABSTRACT: introduction: The Egr-1 protein is a transcriptional factor responsive to early growth. Transcriptional regulation of the promoter has been described like responsive to physical stress, osmotic changes, and cellular growth marker. However, there is no report about the pharmacological effect on the transcriptional regulation in gliomas. Hereby we report the modulation of the Egr-1 promoter transcriptional activity induced by the Granulocytes Macrophages Colony Stimulating Factor (GM-CSF) and steroid drugs in human glioma cells (CH235-GM Grade II, U373-GM Grade III, D54-GM Grade IV) using a reporter system transduced by a recombinant adenoviral vector AdEgr-1/luc7. Methods: Human glioma cells shows with different malignity grade (CH235-GM Grado II; U373-GM Grado III; D54-GM Grado IV) were transduced with no replicative adenoviral vector AdEgr-1/Luc7 and exposed to drugs as progesterone, β-estradiol and betametasone, and GM-CSF. Transcriptional activity of the egr-1 promoter was quantified by Luciferase reporter gene, cloned downstream to the tata box. Luciferase activity was quantified from whole cell proteins using luminometry assays. Results: U373-GM cell line with GM-CSF, shows an increment on transcriptional activity of Egr-1 promoter, also in endogen way. U373-GM showed a positive regulation of Egr-1, with steroid drugs on the times analyzed. Steroid drugs as progesterone, β-estradiol and betametasone, shows a pleiotropic behavior on CH235-GM and D54-GM, glioma cell lines. Conclusions: Inhibition or activation response of Egr-1 promoter shows new framework to explore a mechanism of action of steroid drugs on genetic and epigenetic regulation on tumoral process.
    Cirugia y cirujanos 01/2013; 81(1):3-13.
  • Cirugia y cirujanos 01/2013; 81(1):1-2.
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    ABSTRACT: introduction: Cerebral palsy is the most common cause of disability among children. Parent's main concerns are the acquisition and improvement of gait. The aim of this study was to compare long term results of the effect of two modalities of gait training. Methods: Quantitative measurement of gait and clinical assessment of the gross motor function classification system and Modified Ashworth Scale were perfomed in 14 patients with Cerebral palsy -spastic hemiplegia and randomizedly assigned into two groups of treatment: the first one using a driven gait orthosis (Lokomat®) and the second a gait training a long a rail inside a hydrotherapy tank. Measurements and assessments, above described, were performed immediately and one year after the treatment concluded. Results: Significant change was observed in the gross motor function classification system from II to I among children (p=0.042) and a positive correlation between the shape functional of the march and the gross motor function classification system (r = 0.54, p = 0.042). Patients on the Lokomat® training improved on gait symmetry over patients on the conventional therapy (p = 0.05). A year after, this intervention showed tendency to kept the gait patterns only on patients treated with the Lokomat® Conclusion: Benefit obtained with either modality was evident for both groups. However, residual effects observed on the Lokomat group, either in clinical assessment or gait parameters, were more promising than in the conventional therapy. Due to the size of the sample used in this study the results are not conclusive and more research must be done on this subject in long term time horizon.
    Cirugia y cirujanos 01/2013; 81(1):14-20.
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    ABSTRACT: introduction: Decompressive craniectomy is an alternative in cases where there is increased intracranial pressure. Bone autografts are accepted as a method of reconstruction of the skull. The aim of this paper is to describe the macroscopic and radiological findings of autologous parietal bone in rats after storage in adipose tissue as a reservoir. Methods: We used 20 Wistar rats which underwent a craniectomy. 4 groups were formed: group I, the bone flap fat remained for 14 days, group II, the flap remained for 21 days, in group III, for 28 days and in group IV for 35 days. They were euthanized 70 days after reattached. Results: When removing the flap of subcutaneous fat, a high bright whitish microvasculature and presence in 11 of the flaps. Following 70 days of re-injertarse was found that 56.25% of the animals presented terraced edges, reflecting some consolidation in the radiological analysis 31.25% of cases showed areas of consolidation. Animals in group II and III findings showed more consolidation. Conclusions: The bone flap remained viable during their stay in adipose tissue. Fibrous tissue and neovasculature were important findings that reflect the proper process of bone healing. You need the histological studies complemented biomechanics, neurological and bioacoustics.
    Cirugia y cirujanos 01/2013; 81(1):33-40.
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    ABSTRACT: Background: one of the most used scales for the evaluation of children's pain is the CHEOPS. This is complex, reliable but not commonly used in Spanish. We decided to create a new Pain Facial Scale to be considered to be used in spanish. Objective: to compare the validity and consistency of two different scales for the evaluation of post-operative pain in children. Methods: process, comparative, longitudinal, homodemic, and prolective study. It was elaborated a simple and easy scale, to evaluate the post-operative pain in children. 5 experts evaluated their appearance and content. The original version of CHEOPS was translated to the Spanish by an expert; later this version was corrected and re-translated by a native Anglo-Saxon speaker, the result submitted for evaluation by 5 experts. The validity and consistency of both scales were evaluated by two investigators in a blind way. We used Cronbach's α for the internal consistency of CHEOPS, coefficient of intraclass correlation for the external consistency (inter observer's variability), effect size for sensitivity to the change of category, change of status for internal validity and Spearman's correlation for the convergent analysis. Results: there was great external consistency, and a good and high internal validity, for the Spanish version of the CHEOPS scale, and an excellent internal validity for the Facial Pain Scale, as well as an excellent internal validity for both scales. Conclusions: two scales can be used to evaluate the post-operative pain in children between 4 and 8 years old.
    Cirugia y cirujanos 11/2012; 80(6):510-5.
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    ABSTRACT: Background: intussusception is the most common cause of acute bowel obstruction in infants and young children. Incidence has been reported as 1.5 to 4 cases per 1,000 live births. Most intussusceptions are ileocecocolic; jejunal intussusceptions in children is extremely rare. Clinical case: a 1-year-old male was admitted to the emergency department with diarrheal evacuations, without mucus or blood, crying and irritable. Previously he had melaena in one occasion. The abdomen was found soft and depressible and low pain. He was treated with ceftriaxone, omeprazole and metoclopramide. Two days after admission he had melaena and rectal bleeding. Plain abdominal radiography showed air fluid levels. Abdominal surgery was performed finding jejunal intussusceptions which were reduced. Demonstrable lesion as a lead point was a small tumor that was removed. The pathologist's report showed pancreatic islets cells. Conclusions: jejunal intussusceptions in children are extremely rare and occur at any age. Main symptoms are intermittent abdominal pain and vomiting. Ultrasonography is the study of choice. Often a lesion is demonstrable as a lead point for the intussusceptions and therefore requires open or laparoscopic surgery. In this case, it was unusual to have the presence of ectopic pancreatic tissue as a lead point.
    Cirugia y cirujanos 11/2012; 80(6):546-9.

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