Influence of Islamic religion and spirituality on the well-being and quality of life of cancer patients: a meta-analysis and a hypothetical model of cerebral mechanisms / Influência da religião e da espiritualidade islâmica no bem-estar e na qualidade de vida de pacientes com câncer: uma metanálise e um modelo hipotético de mecanismos cerebrais

OBJECTIVE: To systematically analyze quantitative data about the effects of religion/spirituality and the well-being/quality of life of cancer patients. The second aim was to hypothesize a neurophysiological model of the association between religion/spirituality and the brain. METHODS: This study met the PRISMA Statement and was registered at PROSPERO database. Randomized and Controlled trials investigating religion/spirituality and well-being/quality of life of cancer patients were included. Based on neuroimaging and neurophysiology studies, a neuroanatomical model was developed to hypothesize the relationship between neuroscience and religion/spirituality. RESULTS: A large effect size was found on the improvement of well-being/quality of life (SMD = 3.90 [2.43-5.38], p < 0.01). Heterogeneity was high among studies (I2 = 98%, p < 0.01). Specific regions of the brain, such as the temporal lobes, amygdalae and hippocampus, regions from the limbic system, were hypothesized to take part in the religion/spirituality phenomena and the well-being/quality of life improvement. CONCLUSION: Religion/spirituality intervention, mainly the Islamic, promotes an improvement on wellbeing/quality of life of cancer patients.

OBJETIVO: Analisar sistematicamente dados quantitativos sobre os efeitos da religião/espiritualidade e o bem-estar/qualidade de vida de pacientes com câncer. O segundo objetivo foi levantar a hipótese de um modelo neurofisiológico da associação entre religião/espiritualidade e o cérebro. MÉTODOS: Este estudo seguiu as recomendações do PRISMA e foi registrado no PROSPERO. Estudos randomizados e controlados investigando religião/espiritualidade e o bem-estar/qualidade de vida de pacientes com câncer foram incluídos. Com base em estudos de neuroimagem e neurofisiologia, um modelo neuroanatômico foi desenvolvido para hipotetizar relações entre neurociência e religião/espiritualidade. RESULTADOS: Um tamanho de efeito grande foi encontrado na melhoria do bem-estar/qualidade de vida (SMD = 3,90 [2,43-5,38], p < 0,01). A heterogeneidade foi alta entre os estudos (I2 = 98%, p < 0,01). Regiões específicas do cérebro, como lobos temporais, amídalas e hipocampo, regiões do sistema límbico, foram hipotetizadas como participantes dos fenômenos religião/espiritualidade e melhoria do bem-estar/qualidade de vida. CONCLUSÃO: A intervenção religiosa/espiritual, principalmente islâmica, promove melhora no bem-estar/qualidade de vida em pacientes com câncer.

Prevalence of dementia in long-term care institutions: a meta-analysis / Prevalência de demência em instituições de longa permanência: uma metanálise

ABSTRACT Objective: This study comprises a systematic review and meta-analysis that aimed to estimate the prevalence of dementia in long-term care institutions (LTCIs). Methods: We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Original transversal and longitudinal articles published until July 2020 were eligible in this review. Databases PubMed/MedLine, Web of Science, Scopus and ScienceDirect were searched. Overall prevalence and confidence intervals were estimated. Heterogeneity was calculated according to the index of heterogeneity (I2). Results: One hundred seventy-five studies were found in all databases and 19 studies were meta-analyses, resulting in an overall prevalence of 53% (CI 46-59%; p < 0.01) of demented older adults living in LTCIs. Conclusion: Prevalence of dementia is higher in older adults living in LTCIs than those living in general communities. This data shows a worrying reality that needs to be changed. There is a need for a better understanding of the elements that cause this increase in dementia in LTCFs to direct actions to improve the quality of life and health of institutionalized elderly.

RESUMO Objetivo: Esta revisão sistemática e metanálise objetiva estimar a prevalência de demência em instituições de longa permanência para idosos (ILPIs). Métodos: Utilizou-se o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Artigos originais transversais e longitudinais publicados até julho de 2020 foram elegíveis para esta revisão. As buscas foram conduzidas por meio das bases de dados do PubMed/MedLine, Web of Science, Scopus e Science Direct. A prevalência geral e o intervalo de confiança foram estimados. A heterogeneidade foi calculada de acordo com o índice de heterogeneidade (I2). Resultados: Cento e setenta e cinco estudos foram encontrados em todas as bases de dados e 19 estudos foram analisados, resultando em uma prevalência geral de idosos com demência de 53% (IC 46-59%; p < 0,01) que habitam em ILPIs. Conclusão: A prevalência de demência é maior em idosos moradores de ILPIs que em idosos da população geral. Tal dado mostra uma realidade preocupante e que precisa ser modificada. Há necessidade de melhor entendimento dos elementos que causam esse aumento de demência nas ILPIs para direcionar ações para melhorar a qualidade de vida e a saúde dos idosos institucionalizados.

Factorial validity and measurement invariance of the Psychosocial Uncertainty Scale

Abstract This study presents the development of the Psychosocial Uncertainty Scale (PS-US), which articulates the perception of uncertainty in the social context and its psychological experience. It was validated with a sample of 1596 students and active professionals (employed and unemployed). By randomly dividing this sample in three subsamples, the following analyses were performed: exploratory factor analysis (sample one: N = 827); preliminary confirmatory factor analysis identifying the final version of the scale (sample two: N = 382); confirmatory factor analysis (sample three: N = 387). Multi-group analysis was used to assess measurement invariance, gender, sociocultural level, and group of origin invariance, by using samples two and three. Group differences were explored with the complete sample through Multiple Indicators and Multiple Causes (MIMIC) Models. Associations between this scale and the Uncertainty response Scale were explored through Structural Equation Modelling. Exploratory and confirmatory analyses' results showed good internal consistency and overall good psychometric qualities. The scale reached full metric invariance across groups, gender, SCL level and group of origin. Results highlight the sensitivity of the scale towards social vulnerability, proving the existence of sociocultural levels' effects on experiences of psychosocial uncertainty within working contexts, relationships and community living and self-defeating beliefs; and gender and students versus professionals' effects on psychosocial uncertainty. Furthermore, the scale associated significantly with Uncertainty Response Scale's dimensions, specifically with emotional uncertainty, which can be considered a self-defeating strategy. Results suggest that emotional coping strategies, are explained by psychosocial uncertainty by 57%, and so, may have social origins.

Síncope / Syncope

El síncope es una pérdida transitoria de conciencia y tono postural debido a hipoflujo sanguíneo cerebral que se recupera espontáneamente sin maniobras de RCP. En esta actualización se plantea el síncope vasovagal con sus diagnósticos diferenciales y posibles etiologías, fisiopatología y métodos de estudios. También se presenta la experiencia sobre este tema en nuestro hospital su estudio, tratamiento y diagnostico (tilt test) (AU)

Syncope is a transient loss of consciousness and postural tone due to cerebral blood hypoflow that recovers spontaneously without CPR maneuvers. This update discusses vasovagal syncope with its differential diagnoses and possible etiologies, pathophysiology, and diagnostic methods. Additionally, the experience on this topic of our hospital regarding investigations, treatment, and diagnosis is presented. (AU)

Factorial validity and measurement invariance of the uncertainty response scale

Abstract This study presents the adaptation of the Uncertainty Response Scale (Greco & Roger, Pers. Individ. Differ, 31:519-534, 2001) to Portuguese. This instrument was administered to a non-clinical community sample composed of 1596 students and professionals, allowing a thorough validity and invariance analysis by randomly dividing participants into three subsamples to perform: an exploratory factor analysis (sample one: N = 512); a preliminary confirmatory factor analysis to identify the final solution for the scale (sample two: N = 543); and the confirmatory factor analysis (sample three: N = 541). Samples two and three were also used for multi-group analysis to assess measurement invariance, invariance across gender, sociocultural levels, and students versus active professionals. Results showed the scale reflects the original factorial structure, as well as good internal consistency and overall good psychometric qualities. Invariance results across groups reached structural invariance which provides a confident invariance measurement for this scale, while invariance across gender and sociocultural levels reached metric invariance. Accordingly, differences between these groups were explored, by comparing means with multi-group analysis to establish the scale's sensitivity toward social vulnerability, by demonstrating the existence of statistically significant differences regarding gender and sociocultural levels on how individuals cope with uncertainty, specifically in terms of emotional strategies, as a self-defeating strategy. Thus, females scored higher on emotional uncertainty, as well as low sociocultural levels, compared with higher ones. Therefore, it is proposed that this scale could be a sound alternative to explore strategies for coping with uncertainty, when considering social, economic, or other environmental circumstances that may affect them.

Predictors of Nerve Stimulator Success in Patients With Overactive Bladder / 대한배뇨장애요실금학회지

PURPOSE: To identify factors associated with successful sacral nerve stimulator (SNS) trial after SNS implantation for the treatment of medication refractory overactive bladder (OAB). METHODS: Patients undergoing treatment for OAB at Lahey Hospital and Medical Center between 2004 and 2016 were identified. Patients undergoing SNS placement were identified; SNS success was defined as permanent implantation of the SNS. Demographic, clinical and treatment data were extracted from patient charts; uni- and multivariate analyses were conducted to identify factors associated with SNS treatment success. RESULTS: A total of 128 patients were included. On univariate analysis, male sex, prior diagnosis of benign prostatic hyperplasia, and lower volume at first urge on urodynamics (UDS) were associated with unsuccessful SNS trial. On multivariate analysis, male sex (odds ratio [OR], 0.145; 95% confidence interval [CI], 0.036–0.530) and lower volume at first urge on UDS (OR, 0.982; 95% CI, 0.967–0.995) were associated with unsuccessful SNS trial. A threshold value of 100 mL at first urge during preoperative UDS had a specificity of 0.86 in predicting SNS success in men. CONCLUSIONS: SNS is frequently successful at relieving OAB symptoms. Male patients and those with lower volumes at first urge on UDS, particularly below 100 mL, are more likely to have an unsuccessful SNS trial. Patients in these groups should be counseled on the lower likelihood of SNS success.

Tiroiditis de Riedel, una entidad fácilmente confundible con carcinoma anaplásico tiroideo / Riedel's thyroiditis, an entity easily confused with anaplastic thyroid carcinoma

INTRODUCTION: Riedel´s thyroiditis is a thyroid inflammation with invasive fibrosis. CASE REPORT: Female 84 years old, studied by dysphagia to liquids and dysphonia, with cervical mass poorly demarcated and immobile. Computed Tomography (CT) (CT) showed tumor that diverted the trachea and esophagus compressed. Fine Needle Aspiration (FNA) obtained cells with atypia. Thyroidectomy was performed, appreciating a stony tumor which included the right recurrent laryngeal nerve. Given the high suspicion of thyroid malignancy tracheostomy it was performed. The pathology report as fibrosing Riedel thyroiditis. DISCUSSION: This is the less common type of chronic thyroiditis. Etiology is unknown. The normal thyroid parenchyma is replaced by fibrous connective tissue. Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. Puncturing the mass could give us the diagnosis but is often difficult. Treatment to relieve symptoms or rule out malignancy is surgery. The prognosis is usually good. CONCLUSIONS: Riedel´s thyroiditis is an entity with histopathologic diagnosis essential

Evaluation of food retention in occlusal surfaces of first primary molars / Evaluación de la retención de alimentos en las superficies oclusales de los primeros molares temporales

Some food characteristics, like stickiness and consistency, can modify the time for food removal from the mouth as well as favors the activity of cariogenic bacteria, increasing dental caries risk. This study aimed to observe food retention in contact with a cariogenic substrate in 24-30 months old children. Therefore, 27 children (54 teeth) were evaluated. They intake a chocolate cookie and the food retention area was documented by digital photography in two experimental times (to: 0 and t1: 30 minutes) and it was calculated using Image Tool 3.0 software. The food retention surface index (mm2) was statistically reduced (Wilcoxon’s test, p=0.001) after 30 minutes for both maxillary (to: 0.37 +/- 0.04 and t1:0.042 +/- 0.015) and mandibular (to: 0.30 +/- 0.03 and t1: 0.078 +/- 0.019) molars. No differences were observed between the groups in food retention surface index at the initial time. At the final time, the mandibular molars show a higher retention area than the maxillary ones (Mann-Whitney’s test, p=0.04). The prevalence of food retention at the mandibular molars is higher than the maxillary molars (Chi Square’s test, p=0.03). In conclusion, first primary mandibular molars retain more food than the maxillary molars, being in agreement with clinical results of dental caries’ prevalence.

Algunas características de los alimentos, como la viscosidad y consistencia, puede modificar el tiempo para el retiro de alimentos de la boca, así como favorecer la actividad de las bacterias cariogénicas, y el aumento de riesgo de caries dental. Este estudio tuvo como objetivos verificar la retención de alimentos en contacto con un sustrato cariogénico en niños de 24-30 meses de edad. 27 niños (54 dientes) fueron evaluados. Se realizo la ingesta de una galleta de chocolate, y la zona de retención del alimento fue documentada por la fotografía digital en dos tiempos de experimentación (to: 0 y t1: 30 minutos) y se calculó utilizando el software Image Tool 3.0. El índice de superficie (mm2) de retención de alimentos fue estadísticamente reducido (test de Wilcoxon, p = 0,001) después de 30 minutos para molares maxilares (to: 0,37 +/- 0,04 y t1: 0,042 +/- 0,015) y mandibulares (to:0,30 +/- 0,03 y t1: 0,078 +/- 0,019). No se observaron diferencias en El índice de superficie de retención de alimentos entre los grupos en el tiempo inicial. En el momento final, los molares inferiores muestran una zona de retención superiores a los maxilares (prueba de Mann-Whitney, p = 0,04). La prevalencia de la retención de alimentos en los molares inferiores fue más alta que los molares superiores (Chi cuadrado, p = 0,03). En conclusión, los primeros molares mandibulares primarios retienen más alimentos que los molares superiores, siendo concordante con los resultados clínicos de la prevalencia de caries.

Comparison of small mammal prevalence of Leishmania (Leishmania) mexicana in five foci of cutaneous leishmaniasis in the State of Campeche, Mexico / Comparación de las prevalencias de Leishmania (Leishmania) mexicana en mamíferos pequeños en cinco focos de leishmaniosis cutánea en el estado de Campeche, México

In the Yucatan Peninsula of Mexico, 95% of the human cases of Cutaneous Leishmaniasis are caused by Leishmania (Leishmania) mexicana with an incidence rate of 5.08 per 100,000 inhabitants. Transmission is limited to the winter months (November to March). One study on wild rodents has incriminated Ototylomys phyllotis and Peromyscus yucatanicus as primary reservoirs of L. (L.) mexicana in the focus of La Libertad, Campeche. In the present study, the prevalence of both infection and disease caused by L. (L.) mexicana in small terrestrial mammals were documented during five transmission seasons (1994-2004) in five foci of Leishmaniasis in the state of Campeche. Foci separated by only 100 km, with similar relative abundances of small mammals, were found to differ significantly in their prevalence of both symptoms and infection. Transmission rates and reservoir species seemed to change in space as well as in time which limited the implementation of effective control measures of the disease even in a small endemic area such as the south of the Yucatan Peninsula.

En la Península de Yucatán, México, la Leishmaniosis Cutánea es causada por Leishmania (L.) mexicana en 95% de los casos humanos, con una incidencia de 5.08% por cada 100,000 habitantes. El ciclo de transmisión se limita a la estación de invierno (noviembre- marzo). Un estudio de mamíferos silvestres incrimina a Ototylomys phyllotis y Peromyscus yucatanicus como reservorios primarios de L. (L.) mexicana en el foco de infección de La Libertad, Campeche. En el presente estudio, se documenta la prevalencia de infección/enfermedad causada por L. (L.) mexicana en pequeños mamíferos, durante cinco estaciones de transmisión (1994-2004) en cinco focos de CL del estado de Campeche. Los focos separados por solamente 100 km. de distancia, aún cuando tienen abundancias relativas de pequeños roedores similares, fueron significativamente diferentes en relación a la prevalencia de síntomas así como de infección. Las tasas de transmisión y las especies de reservorios parecen estar cambiando tanto en el tiempo como en el espacio, lo cual impide el establecimiento de adecuadas medidas de control de la enfermedad aún en un área endémica tan pequeña como lo es el sur de la Península de Yucatán.

Importancia del tiempo de suspensión del uso combinado de aspirina y clopidogrel en pacientes sometidos a cirugía de revascularización coronaria / Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery

The combined use of aspirin and clopidogrel is the standard of care for patients with acute coronary syndromes. The risk for perioperative bleeding is considerably increased after coronary artery by-pass graft surgery (CABG). This study was designed to evaluate the effect of antiplatelet therapy on perioperative CABG outcome. We studied 49 consecutive patients undergoing first time CABG, and compared two groups: Group A, patients who stopped antiplatelet treatment at least 6 days before surgery, and group B, those who received antiplatelet therapy within 5 days before surgery or did not suspended therapy. The groups were comparable in their demographic characteristics, manifestations of disease, perioperative medication use and the characteristics of surgery. There was a non significant tendency for more cardiovascular complications (primary cardiovascular endpoint) in the group that stopped antiplatelet therapy 6 or more days before surgery (Group A 12%, group B 8%; p = 0.923). The bleeding endpoint was significantly higher in group B, that remained on antiplatelet therapy within 5 days before surgery (Group A 4%, group B 29%; p = 0.023), as well as the need for transfusion. We concluded that the combined use of aspirin and clopidogrel before CABG increases postoperative bleeding and morbidity; there was no definitive difference in the cardiovascular outcome.

Evolución del cáncer gástrico en 30 años 1975-2005 / Changes in location and pathological type of gastric cancer in the period 1975-2005

El Cáncer Gástrico, se considera la segunda causa de muerte por neoplasia en el mundo después del Cáncer de Pulmón, y en Chile ocupa el primer lugar. En el presente trabajo se analizan algunas características histológicas y epidemiológicas del cáncer en forma evolutiva entre los años 1975-2005. Los resultados muestran que, en general, el Cáncer Gástrico es de mayor prevalencia en hombres, que aumentó en la incidencia del tipo histológico difuso y que en cuanto a la localización, ésta se está presentando mas frecuentemente a nivel del tercio proximal. A través de este estudio se logran evidenciar los cambios evolutivos ocurridos en el Cáncer Gástrico en Chile, tomando como muestra la casuística observada en el Hospital Clínico de la Universidad de Chile a lo largo de los últimos 30 años.

Background: Gastric cancer is the first cause of cancer death in Chile. Aim: To study the changes in epidemiological and pathological features of gastric cancer that occurred between 1975 and 2005. Material and methods: Analysis of 1193 pathological samples derived from total and subtotal gastrectomies for gastric cancer, performed at a Clinical Hospital between 1975 and 2005. The variables obtained from the reports were age, gender, pathological type, location and depth. Results: The pathological samples came from 803 males and 308 females. There was an increase in the frequency of diffuse type of carcinoma since 1985. In the last decade, 40 percent of carcinomas were of this pathological type. Among patients operated in the first decade of the study period, 60 percent of lesions were located in the inferior 2/3 of the stomach. However in the last decade 45 percent of lesions were in the upper third of the stomach. Conclusions: Gastric cancer predominates in males. The diffuse type became the main pathological type in the last decade. In the same period, almost half of the lesions were located in the upper third of the stomach.

Micosis sistemicas: paracoccidioidomicosis / Systemic mycosis: paracoccidioidomycosis

Los hongos son organismos eucarióticos, que se diferencian de las plantas en que no tienen clorofila y no realizan la fotosíntesis de materia orgánica a partir de la luz solar por lo que para vivir, tienen que buscar su fuente de materia orgánica en otros seres vivos, vegetales, animales o incluso el hombre, a cuyas expensas viven. Finalmente despuÚs de agotar la materia orgánica que parasitan dejan sólo materia inorganica como sales minerales que le sirven a las plantas para reiniciar el proceso de la vida. Describiremos la paracoccidioidomicosis, micosis sistémica, causada por el hongo dimórfico Paracoccidioides brasiliensis. Para el mismo genero Paracoccidioides se ha demostrado que existen diversas especies (sp) en distintos lugares geográficos de AmÚrica Latina, siendo esta la micosis sistémica més frecuente. Se transmite por inhalación de esporas (artroconidios), las que se localizan en la mucosa respiratoria y se enfrentan a la primera barrera del huésped, los macrófagos broncoalveolares, los que si no son eficientes ante este agente, los artroconidios se dirigen desde ahí hasta cualquier parte del organismo. También se transmite por contacto de heridas o lugares húmedos de sustrato orgánico con esporas infectivas (tierra o vegetales, por ejemplo). Se presenta en el hombre, en cualquier edad, sexo, raza y en animales, así como tambiÚn en vegetales, alimentos y en el suelo. Se puede presentar como infección subclínica o ser de evolución aguda, subaguda o crónica e incluso causar la muerte, fundamentalmente por mal manejo diagnóstico y terapéutico, sobre todo cuando se hace manejo quirúrgico. Se ha sostenido hasta hoy en la literatura por muchos años, que se trata de una micosis endémica de América Latina en sus regiones tropicales y que no existe en Chile. Nosotros desde 1993, hemos reportado casos fuera de estas áreas, hemos señalado que en Chile se presentan en formas clínicas diferentes a las diagnosticadas en los países tropicales, lo que se pone en evidencia con innumerables casos que hemos diagnosticado y tratado exitosamente desde hace 10 años. Por ello, incluso, es posible renombrar la especie chilena de Paracoccidioides.

A amnioscopia como método de avaliação de risco fetal e perinatal / The aminoscopy as method of the avaliation fetal and perinatal risk

Esta pesquisa constata que a utilização da amnioscopia é um dos métodos importantes para a avaliação de risco e para a diminuição da mortalidade perinatal nas instituições de saúde. A pesquisa mostra também a necessidade da modernização do amnioscópio visando a documentação dos resultados. Este trabalho foi realizado nos hospitais da grande São Paulo e deixa claro que os amnioscópios, da forma que vem sendo utilizados, apresentam fatores de risco para os profissionais que realizam o exame. Portanto é crucial o desenvolvimento de um equipamento que minimize as dificuldades encontradas

Incidencia de displasia broncopulmonar / Incidence of bronchopulmonary dysplasia

Se determinó retrospectivamente la incidencia de displasia broncopulmonar en el total de recién nacidos sometidos a ventilación artificial en una unidad de neonatología, analizándola según peso al nacer y comparándola con la observada en el subgrupo de recién nacidos ventilados sobrevivientes a los 28 días de edad. Se estudió la posible asociación entre displasia broncopulmonar, enfermedad de membrana hialina, ductus arterioso permeable y rotura alveolar. El número de pacientes ventilados fue 200, de los cuales 9,5 por cento presentaron evidencias de DBP (19/200), falleciendo 1 de ellos (letalidad 5,2 por cento). La incidencia aumentó en forma progresiva en los niños de menor PN, hasta llegar a 37,5 por cento en los de <1.000 g (p <0,001 X*). Al considerar los sobrevivientes a los 28 días en este mismo grupo de PN la incidencia fue 75 por cento (p < 0,05 (Fisher)). Se puede plantear que en la medida que aumenta la sobrevida de los RN de muy bajo peso, aumenta también la incidencia de DBP. Se encontró una asociación significativa entre DBP con DAP y RA, DAP se presentó en 33/181 vs. 10/19 (p < 0,01) y RA en 16/181 vs. 6/19 (p <0,01) en el grupo sin DBP vs. el grupo con DBP. La presencia de EMH no mostró diferencias significativas en ambos grupos

La ultrasonografía como método diagnóstico en traumatismos y heridas abdominales / Ultrasonography as diagnostic method in abdominal trauma and wounds

Los traumatismos abdominales constituyen un problema de salud pública. El diagnóstico precoz de las lesiones intrabdominales incide directamente sobre la sobrevida de los enfermos. Practicamos el examen ultrasonográfico del abdomen en 35 pacientes que ingresaron al Hospital Militar "Dr. Carlos Arvelo" de Caracas durante los años 1987 y 1988. Encontramos que el líquido libre en la capacidad abdominal y los hematomas intraparenquimatosos fueron los hallazgos más frecuentes, seguidos por los hematomas retroperitoneales. La correlación entre los hallazgos ultrasonográficos y la evolución de los pacientes fue positiva en el 100% de los casos, tanto para aquéllos en quienes el estudio fue normal, cuya evolución clínica fue satisfactoria, como para los que requieron intervención quirúrgica. Consideramos que el examen ultrasonográfico del abdomen, practicado por personal entrenado y con experiencia, puede aportar en forma rápida información de gran utilidad para el manejo de pacientes con traumatismos abdominales y constituye por tanto, una exploración de primera línea en estos casos

Alteraciones ultrasonográficas de la pared vesicular en patologías no vesiculares / Ultrasonographic alterations of the gallbladder wall in non-gallbladder diseases

Las alteraciones de la pared vesicular constituyen elementos fundamentales en el diagnóstico ultrasonográfico de colecistisis aguda. Sin embargo la pared vesicular puede aumentar su grosor y modificar su aspecto ultrasonográfico en múltiples afecciones sin que exista colecistopatía. detectamos este fenómeno en las siguientes enfermedades: cirrosis hepática, hepatitis viral, mononucleosis infecciosa, hepatitis por halotano, insuficiencia hepática fulminante, por pancreatitis aguda necro-hemorrágica, paludismo a falciparum, enfermedad de Wilson, sepsis, absceso hepático piógeno, absceso hepático amibiano, insuficiencia cardíaca congestiva, desnutrición por obstrucción gástrica y en un paciente de 15 años con fractura de cráneo-anemia aguda-shock. En la mayoría de los pacientes el proceso patológico involucraba al hígado directa o indirectamente. El conocimiento de estas alteraciones resulta fundamental para evitar un diagnóstico ultrasonográfico errado de colecistitis aguda.

Cirugía del desprendimiento de retina en el Hospital Guillermo Almenara Irigoyen. Informe preliminar / Retinal detachment surgery at Hospital \"Guillermo Almenara Yrigoyen\"

Se presentan 79 pacientes con desprendimiento de retina, operados en nuestro hospital entre Mayo de 1985 y Abril de 1987 con un seguimiento de 6 meses. La edad promedio fue de 46.7 años, el tiempo promedio entre el momento del diagnóstico y el acto operatorio fue de 37 días. El diagnóstico más frecuente fue "desprendimiento de retina idiopático" con un 55.5 por ciento de los casos. La agudeza visual properatoria 20/200 o peor fue del 80.2 por ciento y la agudeza visual postoperatoria 20/100 o mejor fue del 58 por ciento. La recuperación anatómica se logró en un 83.5 por ciento. Concluimos que, pese a tener buena recuperación anatómica, los resultados visuales no fueron buenos, posiblemente por el prolongado tiempo entre el diagnóstico y la operación. La técnica operatoria más usada fue la crioterapia con aplicación de banda e implante (64.5 por ciento).

Ileo biliar. / Biliary ileum

Se compara la rareza relativa de la obstruccion intestinal ocasionada por calculos biliares en pacientes mexicanos con la informada en series de otros autores, y se analizan etiopatogenia, hallazgos clinicos y radiologicos y revision de dos formas de tratamiento quirurgico: enterolitotomia aislada y enterolitotomia mas reparacion de la fistula colecistoenterica. Se informan tres casos del padecimiento y se concluye que factores que afectan la mortalidad por el mismo incluyen diagnostico incorrecto, observacion prolongada, edad avanzada del enfermo, padecimientos acompanhantes y tecnica operatoria inadecuada.mas reparacion de la fistula colecistoenterica. Se informan tres casos del padecimiento y se concluye que factores que afectan la mortalidad por el mismo incluyen diagnostico incorrecto, observacion prolongada, edad avanzada del enfermo, padecimientos acompanantes y tecnica operatoria inadecuada

Estudio preliminar de correlacion clinica, histopatologica e inmunologica de la leishmaniasis cutanea mexicana en el hombre. / Preliminary study of clinical, histopathological and immunological correlation of Mexican cutaneous leishmaniasis in the man

Se estudiaron un total de siete pacientes provenientes de area endemica y con cuadro clinico de leishmaniasis cutanea mexicana.Se les practicaron historia clinioepidemiologica, biopsia, evaluacion de perfil inmunologico (linfocitos T y B, determinacion de inmunoglobulinas y C3) y reaccion inmunitaria especifica (intradermorreaccion de Montenegro y ELISA). Clinicamente no se encontraron diferencias con lo informado en la literatura. El patron histopatologico es caracteristico y diferente a lo encontrado en otras leishmaniasis cutaneas. Inmunologicamente los hallazgos sobresalientes fueron hipergammaglobulinemia en 6/7 (85.71 por ciento) y ELISA positivo en 5/7 (71.42 por ciento). Se discuten las posibles correlaciones y se proponen criterios diagnosticos