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Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

To present a report on the incidence and management protocol of cerebrospinal fluid gusher in cochlear implantation in the national institute of respiratory diseases.We conducted a clinical, longitudinal, retrospective investigation of all the medical charts from implanted patients between October 1999 and December 2016 in the national institute of respiratory diseases to evaluate the incidence of gusher, management protocol and evolution after surgery. Statistical analysis was conducted using Fishers test to find out if there was a relationship between the number of inner ear malformations and gusher severity and between the surgical access to the inner ear (cochleostomy or round window) and gusher severity.276 patients were evaluated, 12 (4.3%) presented gusher during cochlear implantation. Seven had minimal gusher that stopped completely with a fascia seal, three had moderate gusher that required fascia and cartilage and two had severe gusher that required middle ear packing and obliteration of the eustachian tube. There was no statistically significant relationship between the number of inner ear malformations or the surgical access to the inner ear with gusher severity.A thorough evaluation of the imaging study should always be conducted, it should include specific measurements and an individualized management in accordance with gusher severity should always be performed.Presentar un reporte de la incidencia y del protocolo de manejo del gusher del líquido cefalorraquídeo durante la implantación coclear en el Instituto Nacional de Enfermedades Respiratorias.Se realizó una investigación clínica, longitudinal y retrospectiva de los expedientes clínicos de todos los pacientes con implantación coclear entre octubre de 1999 y diciembre de 2016, para valorar la incidencia de Gusher, el protocolo de manejo y la evolución posterior. Se realizó el análisis estadístico utilizando la prueba exacta de Fisher para buscar si había relación entre el número de malformaciones de oído interno y el grado de Gusher, y entre la vía de abordaje al oído interno (cocleostomía o ventana redonda) y el grado de Gusher.Se valoraron 276 pacientes, de los cuales 12 (4.3%) presentaron Gusher durante la implantación coclear. De estos, siete fueron Gusher mínimo y cedió totalmente con el sellado con fascia, tres fueron Gusher moderado que ameritó el sellado con fascia y cartílago, y dos fueron Gusher grave que ameritó empaquetamiento de oído medio y obliteración de la trompa de Eustaquio. No se encontró una relación estadísticamente significativa entre el número de malformaciones del oído interno o la vía de abordaje al oído interno con el grado de Gusher.Debe realizarse una minuciosa evaluación del estudio de imagen prequirúrgico, que incluya la toma de mediciones específicas, y brindar un manejo individualizado según la gravedad del Gusher.

Objective To present a report on the incidence and management protocol of cerebrospinal fluid gusher in cochlear implantation in the national institute of respiratory diseases. Method We conducted a clinical, longitudinal, retrospective investigation of all the medical charts from implanted patients between October 1999 and December 2016 in the national institute of respiratory diseases to evaluate the incidence of gusher, management protocol and evolution after surgery. Statistical analysis was conducted using Fishers test to find out if there was a relationship between the number of inner ear malformations and gusher severity and between the surgical access to the inner ear (cochleostomy or round window) and gusher severity. Results 276 patients were evaluated, 12 (4.3%) presented gusher during cochlear implantation. Seven had minimal gusher that stopped completely with a fascia seal, three had moderate gusher that required fascia and cartilage and two had severe gusher that required middle ear packing and obliteration of the eustachian tube. There was no statistically significant relationship between the number of inner ear malformations or the surgical access to the inner ear with gusher severity. Conclusions A thorough evaluation of the imaging study should always be conducted, it should include specific measurements and an individualized management in accordance with gusher severity should always be performed.

Objective Investigate whether perimodiolar cochlear implants provide a better preservation of residual hearing than straight implants. Study Design and Setting Longitudinal, observational, and comparative study in tertiary center in Mexico City. Forty-eight patients who underwent cochlear implant surgery were included and were divided into two groups depending on whether they received a straight or a perimodiolar implant. The residual hearing of the operated ear was measured audiometrically before and after surgery. Variables analyzed were pure-tone average threshold at 125, 250, and 500 Hz and residual hearing at frequencies from 125 to 8000 Hz. Residual hearing was considered as preserved when audiometric changes were less than 10 dB HL in each variable. Results No statistically significant difference was found in the preservation of residual hearing between the two groups or between individual devices ( P > 0.05 in all variables). Conclusion Straight and perimodiolar cochlear implants seem to preserve residual hearing at similar rates across frequencies.

The aim of this study was to evaluate otoscopic and microscopic changes produced on the healthy mucosa of the middle ear (ME) and tympanic membrane (TM) of guinea pigs after packing with a collagen polyvinylpyrrolidone (CPVP) sponge soaked in hyaluronic acid (HA).In 24 guinea pigs, myringotomy on the right side was created and the ME was packed as follows: Group I (n = 6): Absorbable gelatin sponge (AGS) soaked in saline solution; Group II (n = 6): AGS sponge soaked in HA, Group III (n = 6): CPVP sponge soaked in saline solution, Group IV (n = 6): CPVP sponge soaked in HA. Four weeks after miringotomy, the ME and TM integrity and residual packing material were evaluated otoscopically. Histologically, we evaluated inflammatory changes on the ME mucosa.All animals in Groups I and II showed residual packing material (p.001 ANOVA, TUKEY). Histologically, more inflammation was observed in Groups I, II, and III than in Group IV (p.001 ANOVA, TUKEY). Group IV showed greater fibroblastic reaction (p.02, ANOVA, TUKEY) versus other groups.The CPVP sponge soaked in HA used as ME packing material is biocompatible and nontoxic, because it produces minimal inflammatory changes on the healthy mucosa of the ME and TM of guinea pigs. However, more research with injured mucosa is needed to validate its usefulness in otosurgery.

Packing material is mandatory in middle ear (ME) surgery in order to avoid inflammation, adhesions and fibrotic healing. Collagen polivynil-pirrolidone (CPVP) is a healing modulator, which reduces inflammation and fibrosis. Hence we can hypothesize that packing of the ME with CPVP sponge will lead a good ME healing.The aim of this study was to evaluate the otoscopic and microscopic changes induced on the healthy mucosa of the ME and Tympanic membrane (TM) after packing with CPVP sponge in guinea pigs.Twelve guinea pigs were operated on of right myringotomy. The ME was packed with: Group I (n = 6): Absorbable gelatin sponge (AGS) in SS; Group II (n = 6): CPVP soaked in SS. TM and ME integrity was evaluated otoscopically, as well as residual packing material. Euthanasia was performed on the 4th post-operative week. ME mucosa histologic examination was done.Group I in all the cases showed residual packing material (p0.007 Student's test p0.001 ANOVA). Histologically both groups presented inflammation with polymorphonuclears, in addition group I showed severe lymphocytosis (p0.003 Student's, test p0.001, ANOVA).The CPVP sponge when it is used as material of packing in the OM of guinea pigs produces less chronic inflammatory changes, but more studies with the injured mucosa are required to validate their utility in the otologic surgery.

To compare human immunodeficiency virus viral load (HIVVL) in plasma versus the adenoid HIVVL during highly active antiretroviral therapy (HAART).Adenoid biopsies were taken basally and after 3 and 6 months of treatment. Also, the adenoid diameter by simple endoscopy was measured, and its correlation with adenoid HIVVL was calculated.A public tertiary care human immunodeficiency virus (HIV) hospital research centre. Twenty-seven antiretroviral-naive HIV-infected patients, with a mean age of 34.7 years, were included in the study.Correlation between adenoid diameter and plasma and tissue HIVVL.At 3 months, although plasma HIVVL reduced by almost 5 log to a level below 1 log, adenoid HIVVL only decreased 2.36 log, remaining well over 4 log. At 6 months, plasma HIVVL further decreased to 0.205 log, but adenoid HIVVL remained at 2.424 log. Adenoid diameter also decreased over time, with means at 8.52, 5.61, and 4 mm, respectively. It significantly correlated with plasma and adenoid viral load, but the correlation was higher with the biopsies.HIVVL in adenoid tissue is more resilient to HAART than plasma VL and may need more than 6 months to reach asymptomatic levels. Nevertheless, simple endoscopic measurement of the adenoid diameter is a good indicator of viral load decrease in this tissue.