Reconstruction of midfacial traumatic defects secondary to a gunshot wound (GSW) is one of the most challenging head surgeries. The high impact on the functional and aesthetic quality of life, and the small margin of error to achieve a successful outcome are significant hurdles in the surgical treatment of these cases. Here we report a 33-years old patient who suffered a GSW with an entrance wound penetrating between the soft and hard palate and an exit wound on the right malar region. A description of the case and a systematic review of the literature were conducted. The treatment depends on the type of weapon used, deforming characteristics of the bullet, kinetic energy, place of impact, and general conditions of the patient. GSW generate a particular injury due to their special trauma kinematics. In this case, our patient required extensive reconstructive surgery with interposition of costal cartilage to recover velopharyngeal structure and function, patients treated with this surgical strategy develop fewer complications such as infection, shrinkage, scarring. As demonstrated by this case report, the result can be satisfactory. In order to provide the most beneficial results for the patient, surgical techniques are evolving continuously, improving both structure and function, and increasing the quality of life of the patients. Free flaps are preferred because of the good results reported. Patients treated with this surgical strategy develop fewer complications such as infection, shrinkage, scarring. As demonstrated by this case report, the result can be satisfactory.

Retrocaval ureter is a rare congenital anomaly due to altered development of the vasculature, in which the ureter passes behind the inferior vena cava. This is often secondary vascular variants. Here we present a case about a 41-year-old woman with pain in the right renal fossa, stenotic retrocaval ringlet was established by CT scan. RG showed 43.3 ml/min with obstructive pattern and a bordering left renal exclusion. A laparoscopic transperitoneal approach was realized. Right pyeloureteromy and anteroposition was done. The patient evolved satisfactorily, showed no signs of inflammatory systemic response and continued under post-surgical surveillance until drainage was removed, with progressively diminished serohematic output. Laparoscopic ureteral antero-position with pyeloureterotomy is considered the treatment of choice because it’s a less invasive procedure. We recommend the laparoscopic approach because of a low postsurgical complications risk.

Spina bifida is the most common birth defect of the central nervous system that is compatible with life, and myelomeningocele represents its most frequent form. Congenital myelomeningocele (CMM) has a worldwide incidence of 0.5 to 0.8 per 1,000 live newborns. CMM is a complex condition resulting from incomplete closure of the neural tube, mainly in the lumbosacral region. The objective of the surgical repair of the CMM is the reconstruction of all the tissue layers of the defect, avoiding possible postoperative complications. The aim of this case review is to present a re-epithelialization closure in a patient with a large CMM defect in who primary hermetic closure was not possible because there was too much tension at the edges of the defect. Therefore, human cadaveric split-thickness skin grafts were placed over the dura mater and the aponeurotic layer, covering the entire defect and an adequate healing and completely closure of the defect were observed in eight weeks. The surgical management of large meningomyelocele defects represents a major challenge and no single protocol exists for its reconstruction. The repair of an MMC defect should be performed during the first 72 hours after birth. After neurosurgical closure of the neural tube and dura, the myelomeningocele defect requires good quality skin and subcutaneous tissue with minimal wound tension for stable coverage. Human cadaveric skin grafts are considered a useful technique for temporary wound coverage because they lead to a more natural healing environment, possess ideal properties, and provide a physiological barrier that reduces microbiological contamination, in addition, it acts as a bridge to adhere to and to seal wound beds.

Background: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by arrested B cell development, leading to reduced numbers of B lymphocytes and serum immunoglobulin (Ig) levels, due to mutations in the BTK gene located on the X chromosome (Xq21.3- Xq22). The aim of this study was to describe the clinical and immunologic characteristics of patients with a diagnosis of XLA, seen in a tertiary pediatric hospital in Mexico in the department of immunodeficiency in the last 35 years.Methods: A cross-sectional, retrospective and observational study of patients diagnosed with XLA with follow-up in a reference hospital in Mexico City, in a period of January-1987 to July-2022 was performed, data related to their disease status were taken and statistical analysis were analyzed using SPSS.V.16.0.Results: Information was collected from 44 patients with the diagnosis of XLA. The age of onset was 24 months. The age at diagnosis was 60 months. A delay in diagnosis of 37 months was identified, 54 % of patients required I.V. antibiotics before diagnosis, and 45% had a family member with immunodeficiency. The mean Ig levels were IgG: 359 mg/dl, IgA: 24 mg/dl, and IgM: 25 mg/dl. The 77% had a history of bacterial infections before diagnosis, and 6% had allergic symptoms. The main infection was pneumonia in 75%, acute otitis media in 50%, sinusitis in 59%, meningitis in 13%, cutaneous abscesses in 15%, 36% percent developed complications such as bronchiectasis, and 31% sepsis. Once the diagnosis was established, all patients received Immunoglobulin replacement therapy (IRT). 47% of patients were administered antibiotic prophylaxis.Conclusions: The diagnosis of XLA should be suspected in a patient with recurrent clinical manifestations of encapsulated bacterial infections. The diagnosis is confirmed with serum immunoglobulin levels, two standard deviations below for age, when the flow cytometry is available it can help with the diagnosis. The first contact physician can make the diagnosis.