The use of fully articulating instruments has made significant advancements in minimally invasive surgery with their full spectrum of capabilities being integrated into contemporary robotic systems. Articulating laparoscopic instruments with a wide range of motion, when combined with three-dimensional (3D) laparoscopic imaging, create conditions that closely resemble those of a robotic platform. We present our initial experience with the combined use of these two technologies (3D visualization and HandX (TM)). An 82-year-old female patient underwent surgical repair of a large hiatal hernia due to severe symptoms of gastroesophageal reflux disease. Upper gastrointestinal endoscopy revealed a large sliding hiatal hernia with an incompetent gastroesophageal valve, classified as Hill grade IV. Chest computed tomography demonstrated herniation of a large part of the stomach into the mediastinum. Esophageal manometry showed normal lower esophageal sphincter pressure and adequate relaxation, but impaired esophageal peristalsis. The patient underwent three-dimensional laparoscopic repair of the hiatal hernia with crural approximation and a partial posterior fundoplication (Toupet), using a fully articulating laparoscopic HandX (TM) instrument. The postoperative course was uneventful, and the patient was discharged on the second postoperative day.
Necrotizing fasciitis is a severe, rapidly progressing acute bacterial infection of the soft tissues, with progressive necrosis of the subcutaneous tissue and fascia, often life-threatening. It is characterized by extension of the infection on the fascia level and ischemic necrosis of the overlying tissues. A pathognomonic sign is the marked pain of the affected area that is disproportionate to the external image of the skin corresponding to the area of the lesion. On the other hand, suppurative hidradenitis is a form of chronic obstructive skin disease with varying severity and complications. We present a 57-year-old patient, suffering from chronic hidradenitis suppurative, who presented to the emergency department in septic shock and with signs of necrotizing fasciitis in the perineum. The patient immediately underwent surgical debridement with simultaneously intravenous infusion of broad-spectrum antibiotics, followed by multiple surgical debridements. He remained intubated and hemodynamically unstable throughout his hospitalization and died after a long hospitalization. Necrotizing fasciitis is a diagnostic challenge for the clinician and is accompanied by an urgent need for immediate treatment, which is mainly the extensive surgical debridement without delay. Its coexistence with hidradenitis suppurativa is extremely rare and is an additional factor that worsens the already poor prognosis of this infection.
Background: During 2020, all attention was given to COVID-19, it remains to be assessed whether other factors contributed to the older people in-hospital mortality. Aim: To describe the main factors associated with all-cause in-hospital mortality in older patients with pneumonia. Methods: This cross-sectional study included a total of 332 records, which were collected from December 1, 2020, to January 5, 2021, from a hospital located in Nuevo Le & oacute;n, Mexico. Chi-squares and logistic regressions were performed to determine associations and predisposing factors for in-hospital mortality, respectively. Results: In the general population, an age above 76, having more than one comorbidity, a respiratory frequency > 29, COVID-19 infection, a BMI >30 and a saturation of oxygen/fraction of inspired oxygen ratio (SpO2/FiO2 ratio) <300 were associated with in-hospital mortality. For both, COVID-19 positive and COVID-19 negative, age >76, more than one comorbidity and an RF >29 were associated with in-hospital mortality whereas a BMI >29 and an SpO2/FiO2 ratio <300 was associated with in-hospital mortality only in COVID-19 positive patients. Conclusion: During COVID-19 pandemic, BMI and SpO2/FiO2 ratio marked the difference between COVID-19 and COVID-19 outcomes.
Invasive lobular breast cancer (ILC) is the second most often kind of breast cancer, after the invasive ductal breast carcinoma, with an incidence rate of 10% of all the kinds of invasive breast cancer. It is usually multifocal or bilateral and derives from the lobular breast cells. We present a 49 years old woman who was asymptomatic and who during a random blood test discovered high level of vitamin B12. Endoscopy of the colon showed two masses, one in the cecum and another one in the transverse colon. She underwent extended right colectomy and bilateral ovariectomy and the final biopsy revealed metastatic invasive lobular breast cancer. A recent mammogram before surgery was free of pathology.
Aim: Diabetes mellitus (DM) is one of the most common chronic metabolic diseases, with a steadily increasing prevalence worldwide. Its effective management largely depends on patients' adherence to pharmacological treatment and lifestyle recommendations. To investigate the level of adherence to treatment and lifestyle among individuals with DM and their association with the occurrence of chronic complications. Methods: A cross-sectional study was conducted using an anonymous online questionnaire, which included demographic and clinical characteristics, the 8-item Morisky Medication Adherence Scale (MMAS-8), as well as questions regarding lifestyle habits and chronic complications. Results: A total of 136 individuals with DM participated in the study. Low treatment adherence was recorded in 23.4% of participants, and low adherence was statistically significantly associated with the presence of chronic complications (p = 0.03). Conclusions: Inadequate adherence remains common and is associated with an increased risk of complications, highlighting the need for targeted interventions focused on patient education and support.
