El papiloma invertido bilateral es poco común. Aunque es una neoplasia benigna es importante tenerla presente por su gran posibilidad de recurrencia, invasión y progresión a malignidad. Se han reportado pocos casos en la literatura de papilomas invertidos bilaterales por lo que los autores consideramos oportuno el presente artículo para la documentación de casos como este. Se presenta un caso de papiloma invertido bilateral en un paciente de género masculino de 27 años de edad que acudió por presentar obstrucción nasal e hiposmia. Previamente a la cirugía se realizó nasoendoscopia observándose pólipo en meato medio izquierdo. Se intervino quirúrgicamente mediante septoplastia más cirugía endoscópica funcional de senos paranasales para su resección. El reporte histopatológico reporto papiloma shcneideriano. El papiloma invertido es una neoplasia benigna, debe estar sometido a controles períodos para vigilar una posible recurrencia.
Tracheal stenosis following intubation is a relatively rare but difficult condition. Some degree of airway injury is common following intubation, no matter whether it is prolonged or of short duration. Patient is a 54-year-old woman with a past medical history of severe traumatic brain injury (TBI) and intracerebral hemorrhage, for which she was admitted to the intensive care unit (ICU) for neuroprotection. She remained in the ICU for over two months with prolonged mechanical ventilation and tracheostomy. After full recovery, she developed wheezing and dyspnea. A postintubation tracheal stenosis was diagnosed near the bifurcation of the main bronchus, and surgery was needed. Primary resection and reconstruction were achieved using cross-field ventilation without ECMO through precise surgical planning, intermittent ventilation strategies, and judicious extubating criteria. PTS is an iatrogenic lesion that has declined in incidence thanks to the development of new technology and strict surveillance. Nonetheless, it remains a troublesome complication of a critically ill patient that can severely hinder their recovery and quality of life; therefore, the medical team must remain vigilant at all times to prevent these potentially preventable complications.
Background: Return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) reconstruction (ACLR) is primarily based on clinical and functional criteria. Despite meeting these criteria, a substantial proportion of athletes sustain a second ACL injury, most commonly involving the contralateral knee, suggesting a persistent gap between clinical clearance and biomechanical recovery. Purpose: To determine whether interlimb kinetic asymmetry at the time of RTS is associated with an increased risk of subsequent contralateral ACL injury and whether kinetic asymmetry provides incremental prognostic value beyond conventional RTS criteria. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 500 patients who underwent primary unilateral ACLR and completed biomechanical testing at RTS clearance were included. Interlimb kinetic asymmetry was assessed during a standardized single-leg landing task using force-platform–derived peak vertical ground-reaction force (vGRF) and loading rate. Patients were followed for a mean of 36 months. The primary outcome was contralateral ACL injury. Associations were evaluated using Cox proportional hazards regression. Prognostic performance was assessed using the Harrell concordance index (C-index), time-dependent receiver operating characteristic analysis, calibration plots, and decision curve analysis. Results: During follow-up, 120 patients (24%) sustained a contralateral ACL injury, corresponding to an incidence rate of 8.1 injuries per 100 person-years. Greater interlimb asymmetry in peak vGRF at RTS was independently associated with increased contralateral injury risk (adjusted hazard ratio per 1-SD increase, 1.47 [95% CI, 1.23-1.75]; P < .001). The combined model incorporating conventional RTS variables and kinetic asymmetry demonstrated improved discrimination (C-index, 0.76) compared with the conventional RTS model alone (C-index, 0.64; P < .001). Decision curve analysis showed greater net benefit for the combined model across clinically relevant risk thresholds. Conclusion: Persistent interlimb kinetic asymmetry at RTS is independently associated with an increased risk of subsequent contralateral ACL injury. Athletes demonstrating greater asymmetry at the time of RTS appear to be at increased risk despite successful clinical recovery, suggesting that persistent loading asymmetry may represent a clinically relevant marker of incomplete biomechanical restoration after ACLR.
Precise component positioning in total knee arthroplasty (TKA) influences tibiofemoral mechanics, patellofemoral tracking, and soft-tissue balance. Although robotic-assisted TKA improves alignment accuracy, most comparative studies emphasize mean alignment rather than surgical reproducibility. Variability and outlier rates may better reflect precision. This study compared alignment variability and the proportion of coronal and rotational outliers between robotic-assisted and conventional TKA performed under identical mechanical alignment targets. A retrospective comparative cohort included 300 primary TKAs (150 robotic-assisted, 150 conventional) performed by the same surgical team between 2022 and 2025. Postoperative hip–knee–ankle (HKA) alignment was measured on standardized long-leg radiographs. Rotational alignment was evaluated by computed tomography in a predefined subgroup. Variability was quantified using standard deviation and equality of variance tested with the Brown–Forsythe method. Outliers were defined as deviation > 3° from target alignment. Multivariable logistic regression identified predictors of outlier status. Mean postoperative HKA did not differ between groups (0.4° ± 1.6° robotic vs. 0.6° ± 2.8° conventional; p = 0.41). Robotic-assisted TKA showed lower dispersion (SD 1.6° vs. 2.8°; p < 0.001). Coronal outliers occurred in 6.7
La monitorización hemodinámica durante la cirugía cardiotorácica ha experimentado significativos avances en los últimos años, permitiendo una evaluación más precisa y en tiempo real del estado cardiovascular del paciente. Estos avances han sido impulsados por el desarrollo de tecnologías innovadoras que facilitan la medición continua de parámetros críticos como el gasto cardíaco, la presión arterial y la saturación de oxígeno. Entre las técnicas más destacadas se encuentran el uso de catéteres arteriales pulmonares, dispositivos de ecocardiografía transesofágica y sistemas de análisis de la variación de la presión del pulso. La integración de estas herramientas en el entorno quirúrgico ha mejorado notablemente la capacidad de los equipos médicos para detectar y corregir rápidamente alteraciones hemodinámicas, reduciendo así las complicaciones perioperatorias. Además, la implementación de algoritmos de inteligencia artificial y sistemas de monitoreo no invasivos está emergiendo como una frontera prometedora, ofreciendo la posibilidad de personalizar aún más el manejo hemodinámico basado en las características individuales del paciente. Sin embargo, es crucial continuar con investigaciones que validen la eficacia y seguridad de estas nuevas tecnologías en diferentes contextos clínicos. En resumen, los avances en la monitorización hemodinámica están transformando el abordaje del paciente durante la cirugía cardiotorácica, optimizando los resultados y mejorando la seguridad del paciente.
