Jose Angel Tovar Ramirez, Fabiola E. Padilla Azuara, Lizbeth Garcia Sanchez, Juan M. Baglietto Hernandez, Carlos R. Perez Garcia, Rodolfo L. Valdes Ramos, Jairo I. Mendoza Argaez, Carmen A. Ruiz Meza, Sergio E. Vazquez Lara, Minerva I. Hernandez Rejon, Gabriel U. Hernandez De Rubin
SAR J Sur | Pages : 57-62
DOI : 10.36346/sarjs.2023.v04i04.004
Type 2 endoleak after endovascular aneurysm repair of abdominal aortic aneurysms remains the most prevalent type of endoleak. Depending on the time of appearance, can be classified as primary, or secondary, those that appear after the first month after endoprosthesis implantation. Type II endoleaks, due to retrograde filling of the aneurysmal sac from a collateral artery, constitute the most frequent subgroup. Most of the type II endoleaks resolve spontaneously. Which is why they must be treated. The surgical treatment of type 2 endoleaks is through a transarterial approach, In this case, This technique is complicated even in expert hands, and migration of the coils proximally or distally is not uncommon. In general, EVAR is associated, for the moment, with a non-negligible risk of other postoperative complications, such as ischemic complications, those associated with rupture or mobilization of the endoprosthesis, and endoleaks. These complications can affect up to 35% Of the patients who undergo EVAR compared to 8% After CAC. Of cases, and in addition, in the long-term evolution, failures may occur due to material fatigue, with it, the pressurization of the sac and eventually the evolution towards rupture. Follow-up is something inherent to EVAR.
Alexis Jared Paz Lopez, Brenda Aurora Llanos Salas, Emmanuel Stephano Bracho Ruiz, Jorge Boy Serratos, Sergio Sandoval Tapia, Mariano Tovar Ponce, Rebeca Pamela Parra Enciso
SAR J Sur | Pages : 51-56
DOI : 10.36346/sarjs.2023.v04i04.003
Normocalcemic primary hyperparathyroidism (PHP) has been proposed to be a new phenotype of the disease. It is characterized by persistently high levels of parathyroid hormone (PTH) and normal calcium levels. Since there are no known causes of secondary hyperparathyroidism or PTH elevation, the exact biological mechanism is not known. It could be the first stage of the disease or a unique situation marked by resistance of the kidneys and bones to the effects of PTH. This is a disease that is getting more and more common. It is often found when evaluating perimenopausal women with low bone mass or when evaluating or following up on patients with osteoporosis. Normocalcemic PHP has a diverse and varied phenotype that ranges from cases with no usual PHP symptoms to cases with symptoms and specific complications. The method to diagnosing secondary hyperparathyroidism should focus on ruling out all possible causes, especially vitamin D deficiency (25-OH vitamin D levels less than 30ng/mL) and kidney function impairment (glomerular filtration rate less than 60 mL/min, as measured by CKD- EPI). Not much is known about its past in the wild. Some people get hypercalcemia, but more than 75% of them don't. There don't seem to be any ways to predict who will get hypercalcemia, so measuring total and adjusted calcium levels once a year is recommended. Even though measuring ionic calcium is a part of what it means to have Normocalcemic PHP and is recommended by some writers during follow-up, there are a number of real problems with it that should be kept in mind.
Sergio Sandoval Tapia, Karla Yuniva Quintero Barajas, Erick Gerardo Martinez Martinez, Jose Eduardo Rosales Jimenez, Rebeca Pamela Parra Enciso, Mariano Tovar Ponce, Sergio Ivan Castaneda Rocha, Emmanuel Stephano Bracho Ruiz
SAR J Sur | Pages : 46-50
DOI : 10.36346/sarjs.2023.v04i04.002
Thumb polydactyly, also known as radial polydactyly, is the prevailing manifestation of polydactyly. Its existence has been documented in the hand literature from Digby's initial description in 1645. Preaxial polydactyly, specifically bifid thumb, has been extensively observed, with a frequency ranging from 0.08 to 1.4 per 1000 live births. Traditionally, radial polydactyly is classified into three distinct categories: severe hypoplasia, partial duplication, and entire duplication, which can sometimes be mistaken for pseudo duplication. The classification system developed by Wassel has emerged as the widely accepted standard for the categorization of thumb polydactyly. The classifications of surgical treatment procedures are associated with variations. Thumb duplication is categorized as a "duplication" (group 3) in the International Federation of Societies for Surgery of the Hand (IFSSH)/Swanson classification of congenital malformations of the hand and upper limb. The objective of surgical reconstruction is to achieve a thumb that is both stable and mobile, while also possessing appropriate dimensions and form. The prevailing method of reconstruction often involves the excision of the minor digit followed by the subsequent reconstruction of the major digit. Surgical procedures aim to rectify issues pertaining to deviation, instability, and insufficient dimensions. Moreover, it is worth noting that a significant proportion of instances will necessitate an additional intervention in order to enhance the cosmetic and/or functional result.
Mariano Tovar Ponce, Mauricio Martinez Hurtado, Jose David Simonin Lopez, David Gonzalez Garcia, Claudia Monserrat Perez Quintanar, Jazmin Danae Chavez Hernandez, Horacio Sanchez Espinosa, Carlos Roberto Perez Garcia, Emmanuel Stephano Bracho Ruiz
SAR J Sur | Pages : 41-45
DOI : 10.36346/sarjs.2023.v04i04.001
The condition known as pediatric foot polydactyly can manifest itself in a broad range of malformations, from a single extra digit that is only connected to the rest of the foot by a thin band of connective tissue to intricate central foot duplications that involve the duplication of tarsal bones. The presentation of preaxial polydactyly of the foot is crucial to understand, even though it is quite uncommon. This is because in over half of the cases, several congenital malformations, such as syndactyly and atrial septum defects, have been described. The result of surgical reconstruction should be a foot that is stable, mobile, and pain-free, with five aesthetically pleasing toes. This should allow the patient to wear standard footwear and walk without experiencing any discomfort.
Alexis Jared Paz Lopez, Brenda Aurora Llanos Salas, Michel Vladimir Alamo Hernandez, Emmanuel Stephano Bracho Ruiz, Greta Griselda Reyes Cardenas, Javier Martinez Martinez, Andrea Cecilia Muñoz Covarrubias, Alian Guzman Cardenas
SAR J Sur | Pages : 36-40
DOI : 10.36346/sarjs.2023.v04i03.006
Fibrolamellar carcinoma (FLC), a truly unique and uncommon variation of hepatocellular carcinoma (HCC), accounting for barely 1%–9% of all HCC cases. Fibrolamellar carcinoma, an unclear malignancy, appears to be more commonly observed in youthful individuals without any preexisting liver conditions. The nomenclature "fibrolamellar" originates from the presence of dense fibrous collagen bands enveloping the neoplastic cells. Contrary to hepatocellular carcinoma (HCC), cirrhosis and viral hepatitis infection do not serve as predisposing factors for fibrolamellar carcinoma (FLC). Additionally, FLC is not typically associated with increased levels of serum alpha-fetoprotein. Patients with FLC frequently manifest with nonspecific abdominal discomfort, queasiness, general discomfort, and decreased in body mass. Surgical intervention, specifically resection or liver transplantation, serves as the cornerstone of treatment and represents the sole potentially curative avenue. FLCs, or fibrolamellar carcinomas, have historically exhibited lower responsiveness to chemotherapy compared to conventional hepatocellular carcinomas (HCC). Nevertheless, it is important to note that in cases of advanced FLCs, the utilization of multi-modality treatments has shown promising effectiveness. The purpose of this review is to explain the clinical characteristics, diagnostic techniques, and therapeutic approaches for this uncommon tumor in order to enhance the knowledge of healthcare professionals.
Emmanuel Stephano Bracho Ruiz, Carlos Alberto Nungarai, Mariano Tovar Ponce, Mauricio Martinez Hurtado, Jose David Simonin Lopez, David Gonzalez Garcia, Javier Martinez Martinez
SAR J Sur | Pages : 31-35
DOI : 10.36346/sarjs.2023.v04i03.005
The resolution of small to intermediate-sized anomalies affecting the craniofacial region can pose a formidable problem Proximal neuropathy of the median nerve (MN) is a relatively rare condition, accounting for approximately 1% of all compressive neuropathies affecting the upper limb. The existing body of literature documents two distinct clinical presentations, which are based upon the location of entrapment. These presentations are commonly referred to as pronator teres (PT) syndrome and anterior interosseous nerve (AIN) syndrome. Pronator teres syndrome, also known as median nerve compression in the upper forearm, manifests as a constellation of clinical manifestations and indications. Carpal tunnel syndrome is a dynamic condition that is commonly characterized by the compression of the median nerve within the carpal tunnel. Although relatively uncommon when compared to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are conditions involving compression of the proximal median nerve. These conditions may be considered as potential diagnoses when a patient with carpal tunnel syndrome does not show improvement following conservative or surgical treatment. The process of differential diagnosis primarily relies on the evaluation of symptoms, the analysis of paresthesia patterns, and the identification of distinct patterns of muscle weakness. Initial management of all patients should primarily involve nonsurgical treatment modalities. However, it has been demonstrated through empirical evidence that surgical intervention may produce favorable outcomes. Many surgical methodologies have been established, with the majority of outcome data derived from retrospective case series. A full comprehension of the anatomical structure of the median nerve, possible points of compression, and distinctive clinical manifestations of carpal tunnel syndrome (CTS) is imperative for physicians in order to correctly identify and successfully manage their patients.
Jose Eduardo Rosales Jimenez, Edd Israel Guzman Chacon, Emmanuel Stephano Bracho Ruiz, Erick Gerardo Martinez Martinez, Carlos Roberto Perez Garcia, Saul Martinez Jimenez, Mariano Tovar Ponce, Jorge Boy Serratos
SAR J Sur | Pages : 26-30
DOI : 10.36346/sarjs.2023.v04i03.004
Thyroglossal duct cancer is a relatively rare finding, presenting clinical features that resemble those of a benign cyst, a more common congenital abnormality that may manifest as a lump in the midline or neck area. Thyroglossal duct cysts are a commonly found aberration during the development of the thyroid gland. The prevalence of adenotonsillar hypertrophy is greater than that of branchial cleft abnormalities, and among the pediatric population, it is the second most common cause of neck masses, surpassed only by enlarged cervical lymph nodes. In specific instances, thyroglossal duct cysts have been seen to exhibit a low prevalence of cancer. The diagnosis of thyroglossal duct cancer is commonly made by histological examination of the tumor. In addition, needle aspiration cytology, ultrasonography, and computed tomography are employed as diagnostic tools to differentiate malignant patients from alternative potential diagnosis.
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