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Background and Aims: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures., Methods: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator., Results: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity., Conclusions: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement., (Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied., Objective: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities., Methods: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18-59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed., Results: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), ß2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%)., Conclusions: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

Malformation of the vein of Galen is an uncommon intracranial vascular anomaly that is mainly seen in pediatric patients. It presents with diverse manifestations and variable severity. It consists of dilated deep venous structures in the system of Galen, fed by abnormal arteriovenous communications in the midline. Magnetic resonance imaging and magnetic resonance angiography are better than computed tomography for the study of this condition. The case reported here joins the set of rare cases in which a vein of Galen malformation is discovered in an adult.

Integrated electromyographic activity of masseter and anterior temporal muscles was recorded using bipolar surface electrodes in 33 young adults. Subjects were skeletally classified according to ANB angle reading corrected both for maxillary position and rotation of the jaw. Postural activity for both muscles was higher in Class III subjects than in Class I and Class II, whereas in Class I and II subjects activity was similar. During swallowing, masseter muscle activity in Class III subjects was higher than Classes I and II, whereas anterior temporal muscle activity was not different between Classes III and I. During maximal voluntary clenching, activity was not different among classes. High correlations between electromyographic activity and corrected ANB angle as well as with overjet were observed. Skeletal classification used in the present study may have clinical relevance regarding treatment and prognosis, as well as in the assessment of the relationship between muscular activity and craniofacial characteristics.

In this publication the bionator with extraoral anterior traction is presented. The preparation of the bionator and the headgear fit is demonstrated. The indication for the use of the appliance combination is outlined. The results of a cephalometric study concerning the therapeutic effects are presented. The following changes are especially noteworthy: There is a reduction of the SNA-angle, a significant retrusion of the upper incisors occurs. The mesial drift of the upper 6-year molars is inhibited, a slight posterior rotation of the maxilla is observed. In patients who wore their appliances well, a protrusion of the lower incisors could not be observed.

An anatomic correlation of sonographic images and anatomy in cadavers was undertaken to establish a foundation for sonographically assisted recognition of structures and their relation to pathology. Such information would be useful for orientation purposes during surgery, for biopsies, and for follow-up studies. A specially designed technique of placing metal markers with sonographically guided needles was used. Anatomic cuts and dissections were subsequently performed. Sonographic clinical material obtained during surgery and in postoperative controls was analyzed based on this experimental work and previous investigations in this area. Detailed anatomy of the posterior fossa can be demonstrated with sonography.