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Clinical implications of aberrant anatomy of the common hepatic duct in liver surgery: a systematic review and meta-analysis
(Springer, 2024-09-27) Valenzuela Fuenzalida, Juan José; Avalos Díaz, Constanza; Droguett Utreras, Antonia; Guerra Loyola, Javier; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Oyanedel Amaro, Gustavo; Sanchis Gimeno, Juan; Bruna Mejias, Alejandro; Gkionoul Nteli, Chatzioglou
Introduction: Knowledge of anatomical variants that affect the hepatic duct (HD) are of particular clinical relevance during hepatobiliary surgical procedures. More specifically, the aberrant anatomy of the common HD is the most common anatomical variation affecting the biliary tree. Below, we describe different classifications of anatomical variants that affect this canal. According to Huang's classification, variations are determined depending on the insertion of the right posterior hepatic duct (RPHD). Materials and methods: Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases were investigated until January 2024. The methodological quality was assessed with an anatomical studies assurance tool (AQUA). Pooled prevalence was estimated using a random effects model. For the subgroup analysis, Student's T-test was used. Results: The prevalence rate of aberrant hepatic duct (AHD) was 15% (confidence interval [CI] of 7-22%). The first subgroup had cadavers and images. For the cadavers, the prevalence was 15.83% (CI: 11.22-18.3%), while the images had a prevalence of 22.06% (CI: 18.12-25.33%). This subgroup analysis showed no statistically significant difference between these groups (p = 0.127). The second subgroup comprised the continents where the included studies were from. In this subgroup, no statistically significant differences were found (p = 0.613). Finally, regarding the right or left laterality of the HD variant, there were no statistically significant differences (p = 0.089). Conclusion: A AHD corresponds to a finding that can occur in a significant percentage of our society, which could be an accidental discovery during surgeries or present asymptomatically throughout life and be a cadaveric discovery later. We believe it is important for surgeons to have prior knowledge of the possible variants of HD to prevent possible complications during and after surgery.
Hepatic hilum variations and their clinical considerations in the liver: a systematic review and meta-analysis
(MDPI, 2024-05-18) Valenzuela Fuenzalida, Juan José; Pena Santibañez, Fernanda; Vergara Salinas, Ayline; Meneses Caroca, Trinidad; Rojo Gonzalez, Javiera; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Suazo Santibañez, Juan; Gutierrez Espinoza, Héctor
Background: The liver has a region called the hepatic hilum (HH) where structures enter and exit: anteriorly, the left and right hepatic ducts; posteriorly, the portal vein; and between these, the left and right hepatic arteries. The objective of this review is to know how variants in structures of the hepatic hilum are associated with clinical alterations of the liver. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. The methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). The pooled prevalence was estimated using a random effects model. Results: A total of six studies met the selection criteria established in this study for meta-analysis. The prevalence of hepatic hilus variants was 9% (CI = 5% to 13%), and the heterogeneity was 83%. The other studies were analyzed descriptively and with their respective clinical considerations in the presence of the variant, such as the high incidence of the Michels type III variant; among the portal vein variants, the type III variant of the Cheng classification stands out and in biliary anatomy, and the IIIa variant stands out according to the Choi classification. Conclusions: This review allowed us to know in detail the anatomical variants of HH; the structure with which the greatest care should be taken is the hepatic artery because of the probability of metastatic processes due to increased blood distribution in the hepatic lobules. Finally, we believe that new anatomical and clinical studies are needed to improve our knowledge of the relationship between HH variants and liver alterations or surgeries.
Partial agenesis of the pectoralis major and minor muscle: A cadaveric case report
(Wolters Kluwer Health, Inc., 2024-09-13) Bruna Mejias, Alejandro; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Oyanedel Amaro, Gustavo; Valenzuela Fuenzalida, Juan José
Rationale: The pectoralis major and minor muscles, located in the anterior chest wall, are crucial for upper limb movements. Patient concerns: Their nonsyndromic absence is rare but significant for surgical procedures involving the axillary and pectoral regions. Diagnoses: Ultrasound can confirm the diagnosis and delimit the extent of the muscular abnormality, detect abnormalities of the costal cartilages, among others. Interventions: This descriptive, cadaveric case report involves a formalin-fixed 57-year-old North American male, with no clinical or family history of similar conditions. The study was conducted at the Human Anatomy Laboratory of the School of Medicine of the universidad Finis Terrae in Santiago, Chile, in August 2022. Outcomes: We present a cadaveric case of bilateral partial agenesis of the pectoralis muscles discovered during routine dissection. The pectoralis major muscle exhibited only the clavicular portion, with the sternocostal and abdominal portions absent and replaced by a thin layer of connective tissue bilaterally. The pectoralis minor muscle showed partial muscle fibers only in the most distal and inferior portions bilaterally. Lessons: This case report is significant due to the rarity of this condition without accompanying anatomical variations. Understanding this variant is valuable for clinical situations involving the shoulder and thorax region, such as trauma to the proximal third of the humerus, clavicular region, suprascapular region, and anterior chest wall. It may complicate conservative and/or surgical treatments due to different functional and irrigation patterns in the area and is also important for educating future professionals.
Anatomical variants of the origin of the coronary arteries: a systematic review and meta-analysis of prevalence
(MDPI, 2024-06-24) Valenzuela Fuenzalida, Juan José; Becerra Rodriguez, Emelyn; Quivira Muñoz, Alonso; Baez Flores, Belén; Escalona Manzo , Catalina; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Bruna Mejias, Alejandro; Sanchis Gimeno, Juan; Gutiérrez Espinoza, Héctor; Granite, Guinivere
Purpose: The most common anomaly is an anomalous left coronary artery originating from the pulmonary artery. These variants can be different and depend on the location as well as how they present themselves in their anatomical distribution and their symptomatological relationship. For these reasons, this review aims to identify the variants of the coronary artery and how they are associated with different clinical conditions. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 39 studies met the established selection criteria. In this study, 21 articles with a total of 578,868 subjects were included in the meta-analysis. The coronary artery origin variant was 1% (CI = 0.8-1.2%). For this third sample, the funnel plot graph showed an important asymmetry, with a p-value of 0.162, which is directly associated with this asymmetry. Conclusions: It is recommended that patients whose diagnosis was made incidentally and in the absence of symptoms undergo periodic controls to prevent future complications, including death. Finally, we believe that further studies could improve the anatomical, embryological, and physiological understanding of this variant in the heart.
Use of ketamine in patients with multifactorial neuropathic pain: a systematic review and meta-analysis
(MDPI, 2024-09-03) Bruna Mejias, Alejandro; Baeza, Vicente; Gamboa, Javiera; Baez Flores, Belén; San Martin, Jessica; Astorga, Constanza; Leyton, Javiera; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Becerra Farfán, Álvaro; Oyanedel Amaro, Gustavo; Valenzuela Fuenzalida, Juan José
Neuropathic pain (NP) is a heterogeneous group of conditions characterized by the experience of a number of sensory disturbances including pain, burning sensations, paroxysms of stabbing pain, dysesthesias, allodynia, and hyperalgesia. The above-mentioned sensations may occur in a specific dermatome area or other delimited region of the body. The objective of this review was to analyze the evidence for ketamine in multifactorial neuropathic pain. The research group systematically searched the databases MEDLINE (via PubMed), EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (Cinahl), and the Web of Science. The findings of this review show that different forms of low doses of ketamine (LDK) do not present statistically significant changes for any of the scales included. In this study, the total symptom score [standardized mean difference (SMD) = -3.59, confidence interval (CI) = -4.16 to -3.02, and p < 0.00001], neuropathy impairment score (SMD = -1.42, CI = -3.68 to 0.84, and p = 0.22), and neuropathy symptom checklist (SMD = -0.09, CI = -0.15 to -0.02, and p = 0.01) were taken into account. For finality compared to the use of a placebo, the findings suggest that LDK does not exhibit significant differences in terms of pain reduction and functionality. Moreover, no specific dosages are identified to support the use of LDK in the reduction in NP.
Effectiveness of duloxetine versus other therapeutic modalities in patients with diabetic neuropathic pain: a systematic review and meta-analysis
(MDPI, 2024-06-05) Valenzuela Fuenzalida, Juan José; López Chaparro, Michelle; Barahona Vásquez, Marisol; Campos Valdes, Javiera; Cordero Gonzalez, Javiera; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Oyanedel Amaro, Gustavo; Gutiérrez Espinoza, Héctor
Objectives: Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus (DM) with symptoms like intense pain and impaired quality of life. This condition has no treatment; instead, the pain is managed with various antidepressants, including duloxetine. The aim of this study is to analyze the evidence on the efficacy of duloxetine in the management of DPN. Methods: A systematic search in different databases was conducted using the keywords "diabetic neuropathy", "duloxetine therapy", "neuropathic pain", and "Diabetes Mellitus". Finally, eight studies were included in this meta-analysis. Results: All articles comparing duloxetine at different doses vs. a placebo reported significant differences in favor of duloxetine on pain scales like 24 h Average Pain Severity (standardized mean difference [SMD] = -1.06, confidence interval [CI] = -1.09 to -1.03, and p < 0.00001) and BPI Severity (SMD = -0.70, CI = -0.72 to -0.68, and p < 0.00001), among others. A total of 75% of the meta-analyses of studies comparing duloxetine at different doses showed a tendency in favor of the 120 mg/d dose. There were significant differences in favor of duloxetine when compared to routine care on the Euro Quality of Life (SMD = -0.04, CI = -0.04 to -0.03, and p < 0.00001) and SF-36 Survey (SMD = -5.86, CI = -6.28 to -5.44, and p < 0.00001) scales. There were no significant differences on the visual analog scale (VAS) when comparing duloxetine and gabapentin. Conclusions: Duloxetine appears to be effective in the management of DPN in different pain, symptom improvement, and quality of life scales.
Anatomical variants of the renal veins and their relationship with morphofunctional alterations of the kidney: a systematic review and meta-analysis of prevalence
(MDPI, 2024-04-21) Valenzuela Fuenzalida, Juan José; Vera Tapia, Karla; Urzúa Márquez, Camila; Yáñez Castillo, Javiera; Trujillo Riveros, Martín; Koscina, Zmilovan; Orellana-Donoso, Mathias; Suazo-Santibañez, Alejandra; Sanchis Gimeno, Juan; Bruna Mejias, Alejandro; Gutiérrez Espinoza, Héctor
Background: Variations in renal veins are quite common, and most people do not experience issues due to them. However, these variations are important for healthcare professionals, especially in surgical procedures and imaging studies, as precise knowledge of vascular anatomy is essential to avoid complications during medical interventions. The purpose of this study was to expose the frequency of anatomical variations in the renal vein (RV) and detail their relationship with the retroperitoneal and renal regions. Methods: A systematic search was conducted in the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception until January 2024. Two authors independently carried out the search, study selection, and data extraction and assessed methodological quality using a quality assurance tool for anatomical studies (AQUA). Ultimately, consolidated prevalence was estimated using a random effects model. Results: In total, 91 studies meeting the eligibility criteria were identified. This study included 91 investigations with a total of 46,664 subjects; the meta-analysis encompassed 64 studies. The overall prevalence of multiple renal veins was 5%, with a confidence interval (CI) of 4% to 5%. The prevalence of the renal vein trajectory was 5%, with a CI of 4% to 5%. The prevalence of renal vein branching was 3%, with a CI of 0% to 6%. Lastly, the prevalence of unusual renal vein origin was 2%, with a CI of 1% to 4%. Conclusions: The analysis of these variants is crucial for both surgical clinical management and the treatment of patients with renal transplant and hemodialysis.
Association between the Anatomical Location of Glioblastoma and Its Evaluation with Clinical Considerations: A Systematic Review and Meta-Analysis
(MDPI, 2024-05-07) Valenzuela Fuenzalida, Juan José; Moyano Valarezo, Laura; Silva Bravo, Vicente; Milos Brandenberg, Daniel; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibáñez, Alejandra; Rodríguez Luengo, Macarena; Oyanedel Amaro, Gustavo; Sanchis Gimeno, Juan; Gutiérrez Espinoza, Héctor
Background: Glioblastoma is a primary malignant brain tumor; it is aggressive with a high degree of malignancy and unfavorable prognosis and is the most common type of malignant brain tumor. Glioblastomas can be located in the brain, cerebellum, brainstem, and spinal cord, originating from glial cells, particularly astrocytes. Methods: The databases MEDLINE, Scopus, Web of Science, Google Scholar, and CINAHL were researched up to January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). The statistical mean, standard deviation, and difference of means calculated with the Student's t-test for presence between hemispheres and presence in the frontal and temporal lobes were analyzed. Results: A total of 123 studies met the established selection criteria, with a total of 6224 patients. In relation to the mean, GBM between hemispheres had a mean of 33.36 (SD 58.00) in the right hemisphere and a mean of 34.70 (SD 65.07) in the left hemisphere, due to the difference in averages between hemispheres. There were no statistically significant differences, p = 0.35. For the comparison between the presence of GBM in the frontal lobe and the temporal lobe, there was a mean in the frontal lobe of 23.23 (SD 40.03), while in the temporal lobe, the mean was 22.05 (SD 43.50), and for the difference in means between the frontal lobe and the temporal lobe, there was no statistically significant difference for the presence of GBM, p = 0.178. Conclusions: We believe that before a treatment, it will always be correct to know where the GBM is located and how it behaves clinically, in order to generate correct conservative or surgical treatment guidelines for each patient. We believe that more detailed studies are also needed to show why GBM is associated more with some regions than others, despite the brain structure being homologous to other regions in which GMB occurs less frequently, which is why knowing its predominant presence in brain regions is very important.
Hypoplastic and congenital absence of coronary arteries and Its correlation with clinical implications of cardiac circulation: a systematic review and meta-analysis
(MDPI, 2024-04-18) Bruna Mejias, Alejandro; Del Villar Valdebenito, Javiera; Román, Camila; Alcaíno Adasme, Catalina; Sepulveda Loyola, Walter; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Becerra Farfan, Alvaro; Sanchis Gimeno, Juan; Valenzuela Fuenzalida, Juan José
Background: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.
Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence
(Springer, 2024-05-19) Valenzuela Fuenzalida, Juan José; Rojas Navia, Constanza; Quirós Clavero, Amanda; Sanchis Gimeno, Juan; Rodriguez Luengo, Macarena; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Becerra Farfán, Álvaro; Bruna Mejias, Alejandro; Sepúlveda Loyola, Walter; Iwanaga, Joe
Purpose: The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. Conclusion: The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.
The association between anatomical variants of musculoskeletal structures and nerve compressions of the lower limb: a systematic review and meta-analysis
(MDPI, 2024-03-26) Valenzuela Fuenzalida, Juan José; Inostroza Wegner, Alfredo; Osorio Muñoz, Francisca; Milos Brandenberg, Daniel; Santana Machuca, Andrés; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Bruna Mejias, Alejandro; Iwanaga, Joe; Sanchis Gimeno, Juan; Gutierrez Espinoza, Héctor
Objective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14–0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03–0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01–0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.
Liver X receptor unlinks intestinal regeneration and tumorigenesis
(Springer Nature, 2024-10-17) Das, Srustidhar; Parigi S., Martina; Luo, Xinxin; Fransson, Jennifer; Kern, Bianca C.; Okhovat, Ali; Diaz, Oscar E.; Sorini, Chiara; Czarnewski, Paulo; Webb, Anna T.; Morales, Rodrigo A; Lebon, Sacha; Monasterio, Gustavo; Castillo, Francisca; Tripathi, Kumar P.; He, Ning; Pelczar, Penelope; Schaltenberg, Nicola; De la Fuente, Marjorie; López-Köstner, Francisco; Nylén, Susanne; Larsen, Hjalte List; Kuiper, Raoul; Antonson, Per; Hermoso, Marcela A; Huber, Samuel; Biton, Moshe; Scharaw, Sandra; Gustafsson, Jan-Åke; Katajisto, Pekka; Villablanca, Eduardo J.
Uncontrolled regeneration leads to neoplastic transformation1-3. The intestinal epithelium requires precise regulation during continuous homeostatic and damage-induced tissue renewal to prevent neoplastic transformation, suggesting that pathways unlinking tumour growth from regenerative processes must exist. Here, by mining RNA-sequencing datasets from two intestinal damage models4,5 and using pharmacological, transcriptomics and genetic tools, we identified liver X receptor (LXR) pathway activation as a tissue adaptation to damage that reciprocally regulates intestinal regeneration and tumorigenesis. Using single-cell RNA sequencing, intestinal organoids, and gain- and loss-of-function experiments, we demonstrate that LXR activation in intestinal epithelial cells induces amphiregulin (Areg), enhancing regenerative responses. This response is coordinated by the LXR-ligand-producing enzyme CYP27A1, which was upregulated in damaged intestinal crypt niches. Deletion of Cyp27a1 impaired intestinal regeneration, which was rescued by exogenous LXR agonists. Notably, in tumour models, Cyp27a1 deficiency led to increased tumour growth, whereas LXR activation elicited anti-tumour responses dependent on adaptive immunity. Consistently, human colorectal cancer specimens exhibited reduced levels of CYP27A1, LXR target genes, and B and CD8 T cell gene signatures. We therefore identify an epithelial adaptation mechanism to damage, whereby LXR functions as a rheostat, promoting tissue repair while limiting tumorigenesis.
Aprendizajes sobre la vulneración a la infancia durante la pandemia COVID-19: enfermedad, evidencia y políticas públicas
(Sociedad Chilena de Pediatría, 2024-11-01) Díaz, Franco
La pandemia de COVID-19 ha tenido repercusiones significativas en niños, niñas y adolescentes (NNA), tanto por los efectos directos del virus como por las medidas de salud pública aplicadas. Presentamos un análisis de los aciertos y errores en la respuesta gerontocéntrica a la pandemia, que invisibilizó a los NNA del panorama global, de su salud y ciclo vital. Contraponiéndose con la discreta incidencia de COVID-19 pediátrico, múltiples guías se desarrollaron precipitadamente para terapia, afectando el enfrentamiento de otras enfermedades, por ejemplo, el soporte respiratorio no-invasivo y terapia inhalada. Las medidas de confinamiento y cierre de colegios tuvieron un impacto mínimo en la propagación del virus, desmitificando el rol de supercontagiantes, pero su mantención prolongada se basó en decisiones no respaldadas por evidencia, resultando en una importante pérdida educativa y trastornos psicosociales. La crisis de salud mental en NNA se ha agudizado, con un aumento rápido de depresión y trastornos alimentarios, especialmente en grupos socioeconómicamente vulnerables. Otros ámbitos de salud fueron alterados, como la interrupción de servicios sanitarios preventivos, chequeos rutinarios y vacunaciones, diagnósticos de enfermedades como cáncer y terapias de rehabi-litación. Además, se analiza críticamente la narrativa de los mandatos de uso de mascarillas y vacunas en NNA. En conclusión, reflexionamos sobre los aciertos y errores durante la pandemia en puntos críticos de la salud de NNA, con el fin de aprender y optimizar nuestra respuesta a situaciones futuras. Es imperativo adoptar medidas urgentes para identificar y mejorar en estas áreas, cuyos catastróficos efectos recién comenzamos a entender en NNA, y futuros adultos.
Critical asthma in infancy and toddlers: how can we mechanically discriminate from critical bronchiolitis?
(Wiley, 2024-11-06) Cruces, Pablo; Alcántar, Valentina; Caviedes, Paola; Díaz, Franco
Asthma in infancy and toddlers has been increasingly recognized, referring to recurrent episodes of wheezing, also in mechanically ventilated children [1]. We analyzed the working pressures of the respiratory system under static conditions in a cohort of infants and toddlers with a discharge diagnosis of critical asthma. Also, we compare them with critical bronchiolitis cohort and anesthetized children without respiratory disease (normal physiology). Finally, we aimed to identify consistent thresholds in lung mechanics to discriminate between these conditions.
Reply to letter to the editor regarding “Wound drain in lumbar arthrodesis for degenerative disease: an experimental, multicenter, randomized controlled trial”
(Elsevier, 2024) Molina, Marcelo
We would like to thank Dr Alexander Hammer and Dr. Klaus John Schnake for their interest and perceptive insights concerning our study. In your letter, you raise interesting points of view that we will address in this response.
Low-grade cartilaginous vertebral tumor: a rare cause of spinal cord compression
(Gavin Publishers, 2023-12-19) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana
Introduction: Osteochondroma is the most common benign primary neoplasm, representing up to 36% of benign bone tumors. Its location in the spine is rare, occurring in 4% to 7% of primary tumors in this location, and of these, around one-third present myelopathy secondary to spinal cord compression. Despite its low prevalence described in the literature, in recent years there has been an increase in reported cases. Objectives: To present a rare low-grade cartilaginous tumor with intracanal extension as an etiology of spinal cord compression syndrome with myelopathy. Treatment options were discussed. Material and Method: Informed consent was approved by the patient. Clinical information and images were obtained from the electronic file. A review of the literature was done for its analysis and discussion. Results: 52-year-old man, no medical history. He consulted for a 2-month history of progressive loss of strength on the left lower extremity (LLE). On physical examination, it presents hypoesthesia and 3/5 strength from L2 to S1 myotomes in the LLE. Neurological evaluation, spine CT, and MRI were done. Images show a T7 vertebral body tumor with a large extruded calcified mass occupying 80% of the canal at T6T7 with severe compression of the spinal cord. Surgical management was decided by performing posterior arthrodesis from T4 to T10 with posterolateral tumor resection and spinal cord decompression. The patient woke up with paraplegia after surgery. There was a gradual and significant improvement in the patient’s condition over the first four weeks. After a 6-month of following an intensive rehabilitation program, the patient progressed favorably, pain-free, with normal sensitivity, full recovery to 5/5 strength, walking independently, and some degree of spasticity. At 2 years follow up the patient has only mild gait disturbance secondary to spasticity. Discussion: A case of solitary osteochondroma as a cause of progressive compressive myelopathy was presented. Surgical options are evaluated depending on the location of the tumor, presence of mechanical pain, radiographic spinal alignment, vertebral collapse, posterolateral involvement, and neurological compromise of the spine. Most of the similar published reports show that this clinical picture is more frequent in the context of multiple hereditary exostoses and 132 new cases have been published from 2004 to 2016, which shows a 2.4-fold increase since 2003, of which, 27.2% presented with myelopathic symptoms. Conclusion: Osteochondroma is a rare spine tumor that can produce radicular or myelopathic symptoms. Surgery is recommended in spinal cord compression cases. Surgical options are evaluated depending on the location, morbidity, and complications.
Survey on spinal injections for lumbar degenerative stenosis among spine surgeons in Latin America
(Fortune Journals, 2023-11-09) Molina, Marcelo; Torres, Ramon; Yurac, Ratko; Pantoja, Samuel; Gonzales, Lucio
Introduction: Epidural and facet joint injections are usually used as part of the treatment algorithm for low back and radicular pain. Current clinical practice in Latin America is not well described in the literature. Objectives: Evaluate the indications and techniques of spinal injections (SI) in patients with degenerative lumbar spinal stenosis (DLSS) among spine surgeons in Latin America. Study Design: Cross-sectional, international survey, narrative literature review. Methods: An online survey was sent to spine surgeons and members of the AOSpine Latin America. Data included surgeon geographic information, specialty, time in professional activity, SI indications, and techniques in different scenarios of pain and stenosis localization. Results: A total of 446 surgeons, 291 (65%) orthopedic surgeons, and 155 (35%) neurosurgeons replied to the survey. 92% of spine surgeons indicated a spinal steroid injection to treat DLSS. Most spinal surgeons (54%) would simultaneously perform both peridural and intraarticular lumbar facet (combined) steroid injections in patients with low back pain and radicular pain. Foraminal injection is a preferred technique for patients with central and foraminal stenosis. There are no significant differences in most of the answers between orthopedic surgeons and neurosurgeons. Almost 80% of respondents expect a good result from the injection. However, 86% of surgeons believe injection effects last less than 6 months, and only 12% think surgery will not be necessary in the future. Only 15% of spine surgeons irrespective of specialty adhere to a guideline on spine injections for DLSS. Conclusion: This study provides a global perspective on how Latin American spine surgeons treat patients with DLSS concerning the use of spinal steroid injections. We observed that more than 90% of respondents use this procedure to treat DLSS. There are almost no differences between orthopedic spine surgeons and neurosurgeons when performing SI. A foraminal injection is preferred for lateral recess and foraminal stenosis. Most of the respondents expect to achieve positive results with the procedure, but they believe that its effect will last for less than 6 months and possible need for surgery.
Posterior hemivertebrectomy for correction of congenital kyphosis in adulthood: case report and literature review
(Gavin Publishers, 2023-12-19) Molina, Marcelo; Pereira, Mariana; Khek, Pablo; Ballesteros, José Vicente
Congenital kyphosis is an infrequent cause of kyphosis with a potential severe progressive deformity and neurological damage. There are few reports in the literature about congenital kyphosis focusing on adults. Case presentation: 24-year-old male with progressive dorsal pain, paresthesias, and numbness in his legs. Physical examination demonstrated a rigid kyphotic deformity with tenderness on the apex, neurologically intact. The diagnosis was a T10 butterfly posterior hemivertebra with segmental kyphosis of 48 degrees. The patient was treated surgically with a single posterior procedure, performing a complete T10 hemivertebrectomy and instrumented fixation from T8 to T12. The postoperative assessment demonstrated a segmental kyphosis of 14 degrees with 34º of correction, without surgical complications, and good functional results during 4 years of follow-up. Conclusion: Posterior-only hemivertebra resection is an effective procedure for treating congenital kyphosis, providing an excellent correction of the deformity with a good functional outcome. Intraoperative imaging tools, such as CT scans and navigation systems, can aid in performing the surgery and improve outcomes.
RECOSAN tumors study: analysis of patients with spine surgery due to oncologic pathology
(Fortune Journals, 2024-11-01) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana; Lobos, Daniel; Yurac, Ratko; Otto, Juan Pablo; Barahona, Maximiliano
Introduction: Primary bone tumors of the spine are rare and account for 2.8 to 13% of all bone tumors. On the other hand, the spine is a frequent location for metastatic disease. As local control of the primary tumor pathology continues to improve, survival rates improve, and, by extension, the chance of metastasis increases. Breast, lung, and prostate cancer are the main causes of spinal metastases. The RECOSAN (Santiago Spine Surgery Registry) project is the first multicenter, prospective, and national registry of spinal surgeries in Chile. Purpose: The objective was to describe the epidemiological, diagnostic, surgical information, complications, and biopsy results of patients operated on for tumor pathology in the RECOSAN registry. Materials and methods: The RedCap database of the RECOSAN project’s was used to obtain information on patients who underwent spinal surgery due to tumor pathology in five Chilean hospitals. Information on the biopsies of these patients was requested from the respective hospitals and clinics where they were admitted. Demographic data, surgical history, and results of biopsies performed were collected. Results: Out of 1225 patients admitted to the registry, 82 correspond to spinal surgeries due to tumor pathology. Biopsy reports were obtained from 63 patients who underwent surgical biopsy plus tumor resection and instrumentation. 52% of the patients were male, and the mean age was 57 years. 44% of the biopsies were in the dorsal spine and 40% in the lumbar spine. Of the total number of biopsies performed, 84.1% resulted in tumor lesions. Of these, 66% corresponded to metastases and 34% to primary tumors. The most frequent histological diagnoses were breast carcinoma (20.8%), prostate carcinoma (11.3%) and plasma cell neoplasia (9.4%). The percentage of intraoperative complications of the instrumented patients was 18%, and the percentage of reoperation was 4.7%. There was agreement between the preoperative and final diagnoses based on the biopsy of 66% of the cases, reaching a moderate concordance (Kappa=0.42). Conclusion: Vertebral biopsy is an essential procedure for histological diagnosis in both primary and metastatic tumor lesions. This is the first national multicenter registry in Chile for patients undergoing surgery for tumors. It covers epidemiological data, clinical information, surgical techniques, biopsy results, as well as intraoperative and postoperative complications. In this series, the most frequent histological diagnoses coincide with those reported in the literature. The concordance between the preoperative diagnosis and the biopsy is moderate, which supports the importance of obtaining a biopsy for the treatment of spinal tumor pathology.
Radiological classification for degenerative lumbar spine disease: a literature review of the main systems
(Fortune Journals, 2023-12-29) Molina, Marcelo; Vial, Sebastián
Study Design: Systematic review Objectives: Performed a systematic review of available lumbar spinal degenerative disease classifications. Methods: We performed a systematic literature review search for papers that proposed or described radiological classification systems for degenerative lumbar spine disease, such as lumbar disc herniation, facet joint arthritis, spondylolisthesis, and lumbar stenosis. The literature was performed in MEDLINE and EMBASE, limited to English articles published from 1980 to the present. The reliability tests of the reviewed articles were assessed with the “Intraclass Correlation Coefficients” (ICC) and “Cohen's Kappa coefficient” (k). Results: We found 1873 articles. A total of 64 articles were reviewed, identifying 31 radiological classification systems. We found 7 classifications for degenerative disc disease, 7 for disc herniation, 7 for facet joint osteoarthritis, 8 for degenerative spinal stenosis, and 2 for degenerative spondylolisthesis. Of the 31 systems found, 24 had interrater agreement studies. The clinical orientation of the classification was analyzed when appropriate. Discussion: Reliability studies play a crucial role in evaluating a classification system as they enable reproducibility among evaluators, thereby fortifying the system. Classifications should not only be endorsed based on their validation and reliability studies, but it is also crucial to assess their feasibility for practical implementation in clinical settings. Conclusions: A classification system should have a reliability with Kappa or ICC over 0.60 to be recommended. It should provide a clinical orientation to make therapeutic decisions and form part of a guideline. Continued research on classification development is essential to improve systems, enhancing their clinical utility and bolstering their reliability

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