Experience on the surgical management of biliary stones in Sokoto,North West Nigeria

Background:Cholelithiasis are relatively rare in Nigeria and Africaat large. However, recently the incidence has been reported to be on the rise. We present a ten-year review of our experience in managing gallstones to highlight the recent trends in our practice.Methods:This is a 10-year retrospective study on patients who were managed for gall bladder disease in the Usmanu Danfodiyo university teaching hospital Sokoto from August 2011 to July 2021. The biographic data, clinical features, radiologic, operative findings, histologic findings and outcome of treatment were analyzed with IBM SPSS 25. Results:There were 82 patients over the period of the study comprising of 18 (22%) males and 64 females (78%). Their ages range was 17 to 60 years with a mean of 37.59 years �.02. All patients had right upper quadrant pain as the main complaint with 24 patients (29.3%) having associated epigastric pain and 14 patients (17.1%) presented with jaundice. Preoperative ultrasound (USS) diagnosis was in keeping with intraoperative diagnosis in 97.6%. All patients had cholecystectomy out of which 62 patients (75.6%) had open cholecystectomy while 20 patients (24.4%) had laparoscopic cholecystectomy. There was no hospital mortality, the average hospital stay was 8.2 days following open cholecystectomy however this was shorter, 4.5 days for laparoscopic procedure.Conclusions:The prevalence of gallstones is still comparatively low when compared to the western world. Ultrasonography is very sensitive imaging modality.Laparoscopic cholecystectomy is safe and superior to open surgery in our environment.

Psychosocial consequences and reasons for illicit drug use among police officers in a northern Nigerian city: A mixed-method study

Harmful use of drugs is one of the principal risk factors affecting population health worldwide. Chronic use has been linked to medical, psychological and socioeconomic consequences. This study assessed the psychosocial consequences and reasons for illicit drug use among police officers in Kano, Nigeria. Using a mixed method of data collection, quantitative data was obtained from a cross-section of 275 officers using the Shortened Inventory of Problems-Drug Use (SIP­DU) and a pretested adapted questionnaire. In-depth interviews with 10 officers who used illicit drugs provided additional information. Almost half of the respondents (46.5%, n=128) were in their fourth decade of life with a mean age (±SD) of 35.1 ± 7.7 years. Over a quarter of the respondents (n=75) reported ever using illicit drugs, out of which 14.9% (n=41) were current users. Among the current drug users, 80.5% (n=33) attested to having money problems, 61.0% (n=25) agreed that they had spent too much money, and 56.1% (n=23) failed to do what was expected of them as a result of drug use and have hurt their family. Helping to stay awake and improving confidence were the major reasons (100%, n=41) for drug use mentioned by the respondents. The Nigerian Police Force should look into easing shifts and introducing stress-relieving activities. There is also the need to strengthen substance education and counselling and support officers with confidence issues, sleep disorders, and treat those with mood disorders.

Obesity and response to neoadjuvant chemotherapy in breast cancer

The prevalence of obesity is rising worldwide including Sub-Saharan Africa just as the incidence of breast cancer is rising in same region with increasing morbidity and mortality. Obesity or overweight has been identified as a risk factor for breast cancer and both have been associated with poor outcome of breast cancer treatment. The objective of this study was to assess the effect of obesity /overweight on clinical response to Adriamycin Cyclophosphamide-Paclitaxel (AC-P) regimen neoadjuvant chemotherapy in patients with breast cancer. A prospective observational of 39 female patients with breast cancer. A prospective observational study of newly diagnosed breast cancer patients with palpable breast lumps on neoadjuvant chemotherapy of AC-P regime. Age of the patients, tumour size, stage, estrogen, progestogen and HER2 receptor status were noted. Height measured in metres and weight measured in Kilograms were recorded and Body Mass Index (BMI) calculated .Tumour size measured at presentation, then after first, third, sixth and eighth doses to determine response as defined by the UICC method such as complete clinical response, partial clinical response, stable disease and progressive disease. BMI was then categorized into Normal weight 25kg/m2 and Overweight 25-30kg/m2 and Obese 30kg/m2. 43.6% were obese, 33.3% were overweight and 23.1% were normal weight. Thirty percent of overweight /obese patients had complete clinical response 2 compared with 77% of low/normal weight patients and this was statistically significant (X2 =6.53, p 0.015). 76.7% of the overweight/obese were premenopausal compared with 23.3% who were post menopausal, and this is statistically significant.(X2 =5.84, p 0.024). Obesity/ overweight is associated with poorer clinical response to neoadjuvant chemotherapy in the cohort of patients studied

Concentraciones de Vitamina D en niños y adolescentes con enfermedad celíaca / Vitamin D concentrations in children and adolescents with celiac disease

INTRODUCCIÓN: En celíacos la ingesta de gluten provoca una lesión inflamatoria de origen autoinmune que causa un daño progresivo de las vellosidades del intestino delgado, comprometiendo la absorción de nutrientes y posible daño a otros órganos. OBJETIVO: Determinar las concentraciones plasmáticas de 25-hidroxivitamina D (25OHD) en niños y adolescentes chilenos con enfermedad celíaca. PACIENTES Y MÉTODO: Estudio descriptivo de corte transversal. Participaron 16 pacientes pediátricos de ambos sexos, diagnosticados con enfermedad celíaca. Se determinó antecedentes ge nerales, estado nutricional y parámetros bioquímicos. Las concentraciones plasmáticas de 25OHD se clasificaron como suficientes cuando estaban entre 30-100 ng/ml, insuficiente (20-29 ng/ml) y deficiente (< 20 ng/ml). RESULTADOS: La edad de los pacientes estaba comprendida entre 5 y 18 edad (edad: 11 ± 4 años). De los participantes 4 de 16 presentaron concentraciones normales de 25OHD, 8 insuficiente y 1 deficiente. Según IMC, 11 tenían estado nutricional normal, 4 sobrepeso y 1 obesidad. El diagnóstico de la talla mostró 7 de 16 casos de talla baja y normal baja. Al relacionar las concentraciones de 25OHD con estado nutricional, los parámetros deficientes e insuficientes se concentraron en 9 pacientes con estado nutricional normal, 2 con sobrepeso y 1 con obesidad. Se realizaron asociaciones entre las concentraciones de 25OHD y todas las variables estudiadas y no se encontró ninguna asociación significativa. CONCLUSIÓN: Se encontró una alta frecuencia de insuficiencia y deficiencia de 25OHD en el grupo de niños y adolescentes chilenos con enfermedad celíaca.

INTRODUCTION: In children with celiac disease, gluten intake causes an autoimmune, inflammatory and progressive lesion of the small intestine villi, compromising the absorption of nutrients and pos sible damage to others organs. OBJECTIVE: To determine plasma 25-hydroxyvitamin D [25(OH)D] concentrations in Chilean child and adolescents with celiac disease. PATIENTS AND METHOD: A descriptive cross-sectional study was carried out in which 16 pediatric patients of both genders diagnosed with celiac disease participated. General background, nutritional status and biochemical parameters were determined. Plasma 25(OH)D concentrations were classified as sufficient between 30-100 ng/ ml, insufficient between 20-30 ng/ml and deficient as <20 ng/ml. RESULTS: The age of the patients was between 5 and 18 years (age: 11 ± 4 years). Four out of 16 participants had normal 25(OH)D concentrations, eight had insufficient concentrations and one had deficient concentrations. Accor ding to BMI, 11 patients had normal nutritional status, four were overweight and one was obese. In relation to height, seven out of 16 cases presented short stature and normal-low height. Associating 25(OH)D concentrations to nutritional status, nine patients with normal nutritional status, two with overweight and one with obesity presented deficient and insufficient parameters. No significant asso ciations were found between 25(OH)D concentrations and all studied variables. CONCLUSION: A high frequency of insufficiency and deficiency of 25(OH)D was found in the group of Chilean children and adolescents with celiac disease.

L- Arginine and Nitric Oxide Levels among Children with Sickle Cell Disease in a Steady State in Federal Teaching Hospital Gombe, Northeastern Nigeria

Sickle cell disease is a global public health problem. L-arginine is an amino acid that helps in improving blood in the arteries of the heart and improved symptoms of clogged arteries, chest pain or angina and coronary arteries disease. Nitric oxide is a powerful neurotransmitter that helps blood vessels relax and improve circulation. The l-arginine and nitric oxide levels of sickle cell disease (SCD) subjects with steady stages were also significantly low. The objective of this study was to evaluate L-arginine and Nitric oxide levels in children with sickle cell disease at steady state for 8 weeks. This study included children with a confirmed HbSS electrophoretic pattern aged 1-14 years presented to the sickle cell clinic unit of Federal Teaching Hospital Gombe. The L-arginine and nitric oxide levels were significantly higher post supplementation compared to baseline levels (p = 0.002 and 0.000 respectively). It is recommended that L-arginine supplementation be included in the management of patients with sickle cell disease. L-arginine supplement should be made available in the paediatric emergency unit, clinic and pharmacy department as given to patients with sickle cell disease to prevent the adverse effects during the crisis and potentially reduce the length of stay in the hospital.

Biochemical Assessment of the Effects of Aqueous Stem Bark Extract of Anogeissus leiocarpus on Wistar Strain Rats.

Aqueous stem bark extract of Anogeissus leiocarpus was phytochemically screened indicating the presence of alkaloids, tannins, anthraquinones, saponins and phenols. Antimicrobial activity of the aqueous extract using Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae as test organisms showed varying zones of inhibition with 10 mm zone of inhibition exhibited by Staphylococcus aureus and Escherichia coli respectively. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration of extract were 16 μg/ml and 32 μg/ml respectively. Treatment of experimental animals with the aqueous stem bark extract for a period of six weeks and subsequent assessment of its effect biochemically revealed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), acid phosphatase (ACP), and lactate dehydrogenase (LDH) levels were significantly higher than normal suggesting certain degree of liver injury. Glucose, cholesterol, total and direct bilirubin as well as total protein levels were significantly higher than normal values with respect to animals treated with 500mg/kg body weight suggesting a dose dependent effect of the extract on the animals. Urea and creatinine levels were slightly lower than normal. Overall, the result of this study showed that the effect of the extract was more pronounced on the liver than the kidney as depicted by the photomicrographs.

Pattern of Perioperative Cardiac Arrests at University of Maiduguri Teaching Hospital

Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern; causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes; anaesthetic chart and ICU records. Study variables which include demographic data; ASA score; anaesthetic technique; causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia; while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults.ASAclass III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2(14) out of 14 cardiac arrests recovered to home discharge; one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early. There is need to improve on patient monitoring; knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest

DNA mismatch repair gene methylation in gastric cancer in individuals from northern Brazil

Gastric cancer is one of the most common malignancies. DNA methylation is implicated in DNA mismatch repair genes deficiency. In the present study, we evaluated the methylation status of MLH1, MSH2, MSH6 and PMS2 in 20 diffuse- and 26 intestinal-type gastric cancer samples and 20 normal gastric mucosal of gastric cancer patients from Northern Brazil. We found that none of the nonneoplastic samples showed methylation of any gene promoter and 50% of gastric cancer samples showed at least one methylated gene promoter. Methylation frequencies of MLH1, MSH2, MSH6 and PMS2 promoter were 21.74%, 17.39%, 0% and 28.26% respectively in gastric cancer samples. MLH1 and PMS2 methylation were associated with neoplastic samples compared to nonneoplastic ones. PMS2 methylation was associated with diffuse- and intestinal-type cancer compared with normal controls. Intestinal-type cancer showed significant association with MLH1 methylation. Diffuse-type cancer was significantly associated with MSH2 methylation. Our findings show differential gene methylation in tumoral tissue, which allows us to conclude that methylation is associated with gastric carcinogenesis. Methylation of mismatch repair genes was associated with gastric carcinogenesis and may be a helpful tool for diagnosis, prognosis and therapies. However, MSH6 does not seem to be regulated by methylation in our samples.

Methylation status of ANAPC1, CDKN2A and TP53 promoter genes in individuals with gastric cancer

Gastric cancer is the forth most frequent malignancy and the second most common cause of cancer death worldwide. DNA methylation is the most studied epigenetic alteration, occurring through a methyl radical addition to the cytosine base adjacent to guanine. Many tumor genes are inactivated by DNA methylation in gastric cancer. We evaluated the DNA methylation status of ANAPC1, CDKN2A and TP53 by methylation-specific PCR in 20 diffuse- and 26 intestinal-type gastric cancer samples and 20 normal gastric mucosa in individuals from Northern Brazil. All gastric cancer samples were advanced stage adenocarcinomas. Gastric samples were surgically obtained at the João de Barros Barreto University Hospital, State of Pará, and were stored at -80°C before DNA extraction. Patients had never been submitted to chemotherapy or radiotherapy, nor did they have any other diagnosed cancer. None of the gastric cancer samples presented methylated DNA sequences for ANAPC1 and TP53. CDKN2A methylation was not detected in any normal gastric mucosa; however, the CDKN2A promoter was methylated in 30.4 percent of gastric cancer samples, with 35 percent methylation in diffuse-type and 26.9 percent in intestinal-type cancers. CDKN2A methylation was associated with the carcinogenesis process for ~30 percent diffuse-type and intestinal-type compared to non-neoplastic samples. Thus, ANAPC1 and TP53 methylation was probably not implicated in gastric carcinogenesis in our samples. CDKN2A can be implicated in the carcinogenesis process of only a subset of gastric neoplasias.

Meconium peritonitis in nigerian children

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa; there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital; Maiduguri; Borno State; the Lagos University Teaching Hospital; Lagos State; Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife; Osun State and the Federal Medical Centre Gombe; Gombe State; Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy; all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients).The mortality rate was high (50). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis; proper operative procedure and meticulous post-operative care should improve their survival

Cirugía de salvación del miembro en el tratamiento de osteosarcoma de Peroné con supervivencia a los diecisiete años / Salvation surgery treatment in osteosarcoma of the fibula with seventeen years survival

El osteosarcoma es el tumor óseo primario más frecuente habiendo dos picos de incidencia, uno en torno a los 15 años (adolescentes) y otro en ancianos. Caso clínico: Paciente de 14 años con clínica de dolor en región proximal de perné. Se diagnosticó mediante estudios radiológicos y biopsia osteosarcoma localizado con infiltración de cortical y periostio y extensión hacia epífisis de peroné. Tras quimioterapia preoperatorio se realizó exéresis tumoral con márgenes de 5cm. Siguiendo criterios de Enneking (cirurgia de salvación del miembro). Completamos varios ciclos de quimioterapia postoperatoria. La paciente está libre de enfermedad a los diecisiete años. Discusión: Años atrás en el tratamiento del osteosarcoma localizado se procedía a la amputación radical por norma. Actualmente debido al avance de las técnicas quirurgicas y diagnósticas (capaces de detectar precozmente la diseminación local y a distancia del tumor) es posible efectuar otras modalidades terapéuticas que preservan el miembro hasta en terapéuticas que preservan el miembro hasta en el 90% de los pacientes. Gracias al uso de la quimioterapia la tasa de supervivencia hoy dia se aproxima al 70% en aquellos casos diagnosticados previamente a la aparición de metástasis. Actualmente en quellos casos en los cuales la enfermedad esté localizada, el tamaño tumoral sea reducido y haya una buena respuesta a la quimioterapia preoperatoria es más aconsejable optar por una cirugía de salvación del miembro haciendo una prudente resección a distancia de los márgenes de la tumoración y acompañándola de ciclos de quimioterapia combinada.

Osteosarcoma is the most frequent primary bony tumor with two picks of incidence, one around the 15 years (adolescents) and another in old people. CLINICAL CASE: Patient of 14 years with pain clinic in proximal fibula. It was diagnosed by radiological studies and biopsy of located osteosarcoma with infiltration of cortical and periostium and extension toward fibula epiphysis. After preoperatory chemotherapy she was carried out tumoral resection with margins of 5 cm. following approaches of Enneking (surgery of salvation of the member). Several cycles of chemotherapy were completed after surgery. The patient, after seventeen years, is free of illness. DISCUSSION: Traditionally in the treatment of the located osteosarcoma you proceeded to the radical amputation for norm. At the moment due to the advances of the surgical and diagnostic techniques (able to detect precociously the local and distant dissemination of the tumor) it is possible to make other therapeutic modalities that preserve the member until in 90% of the patients. Thanks to the use of the chemotherapy the rate of survival nowadays approaches to 70% in those cases diagnosed previously to the metastasis appearance. At the moment in those cases in which the illness is located, the tumoral size is reduced and have a good answer to the preoperatroy chemotherapy, it is more advisable to opt for a surgery of salvation of the limb making a wise resection at distance of the margins of the tumor and accompanying it of cycles of combined chemotherapy.

Aplicación de encuesta epidemiológica en individuos con discapacidad auditiva de las Unidades de Educación Especial del estado Sucre / Application of epidemic survey in individuals with auditory discapacidad of the Units of Special Education of the state Sucre

Para el año 2002 LA World Health Organization (WHO), estimó que aproximadamente unos 250 millones de personas sufrifrían de trastornos auditivos incapacitantes; que dos terceras partes de estas pesonas vivirían en países en vías de desarrollo, y que la mitad de estas pérdidas auditivas podrían ser evitables. Los programas de WHO, (Healthy People 200) iniciados en 1.990, tenían como objetivo fundamental lograr la identificación de pérdidas auditivas severas en niños antes del primer año de edad, sin embargo, los programas de Joint Comittee of Infant Hearing (1.994) fueron mas ambiciosos y redujeron la identificación del problema a los 6 meses de nacido. El propósito de este trabajo es mostrar los resultados de una encuesta epidemiológica aplicada en las Unidades de Educación Especial (UEE) del estado Sucre: Cumaná (UEE Cumaná), Carúpano (UEE Libertador) y Cumanocoa (UEE Cumanacoa y taller de educación especial Cumanacoa). El objetivo funadmental de esta encuesta era el de establecer las posibles causas que originaron el problema en la población de 3 a 25 años de edad que asisten a estos centros educativos, la edad a la cual se realizó el diagnóstico, el grado de perdida auditiva de los mismos, así como las características de su amplificación aural y escolaridad

Efectividad y tolerabilidad de la citicolina (somazina®): en el tratameinto de pacientes con deterioro cognitivo tipo demencia / Effectiveness and tolerabilidad of the citicolina (somazina®) in the treatment of patient with deterioration cognitivo type insanity

Evaluar la citicolina administrada a dosis de 1000 mg diarios durante 12 semanas en pacientes con criterios de demencia según Mini Mental State Test. (MMST) < 24 puntos, con el fin de observar los cambios en el MMST y en la calidad de vida. Se realizó un estudio, fase IV, prospectivo, abierto, multicéntrico, donde incluyeron pacientes de ambos sexos con edades comprendidas entre 45 y 85 años con deterioro de la función mental por: deterioro mental del anciano o trastornos vasculares crónicos, con un Score en MMST entre 12 y 23, a los cuales se suministró Citicolina (CDP.colina) en gotas a una dosis de 1000 mg., 10 cc (2 cucharaditas) diarias durante 3 meses. La efectividad fue evaluada mediante los cambios en los scores de: Mini Mental State Test, Escala de Calidad de Vida de Barthel, opinión del paciente o cuidador, opinión del médico a los tiempos: 0 días; 1,5 y 3 meses de tratamiento. Ingresaron al estudio 55 pacientes. La mayoría tomaban otro tipo de medicamentos y estos se mantuvieron sin cambios desde el inicio hasta el final del estudio. Se presentó un descenso discreto en las presiones arteriales sistólicas en ambas posiciones y en la presión arterial diastólica en la posición sentada entre el inicio y la 6ta semana sin modificaciones posteriores. Hubo un incremento importante en los promedios del MMST, el 92 por ciento de los pacientes mejoraron los resultados, en el 32 por ciento el cambio fue mayor de 5 puntos y el 18 por ciento tuvo resultados normales al final. Dos de tres pacientes con demencia severa pasaron a demencia moderada (10 a 16 ptos y 10 a 15 ptos). Diez de diecinueve pasaron de demencia moderada a leve y nueve pacientes pasaron de demencia moderada a un puntaje normal. Siete pacientes presentaron efectos adversos: mareos, inquietud, náuseas, diarrea, insomnio, epigastralgia, empeoramiento motor, ira, dos pacientes suspendieron (mareos, ataques de ira) y dos necesitaron tratamiento (mareos: cimnarizina; ira: alprazolan).

Consenso de diagnóstico y manejo de los nódulos tiroideos no palpables / Consensus report on the diagnosis and management of non palpable thyroid nodules

With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term <>, is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the <> statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on tbe management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking.

Gastrectomía total paliativa / Total palliative gastrectomy

El cáncer gástrico ya sea por el compromiso ganglionar extenso (invasión sobre N2), por la extensión local (invasión pancreática, colonial, o hepática) o por las metástasis (hepáticas o peritoneales) frecuentemente permite sólo cirugía de carácter paliativo. Entre los años 1985 y 2000, 51 pacientes (35 hombres y 16 mujeres) con carcinoma gástrico en estadio IV fueron sometidos a una gastrectomía total. La edad media fue de 62,1 años, rango de 34 a 83 años. Se realizó gastrectomía total con omectomía mayor y menor sin intentar linfadenectomía superior a N1. El 37,3 por ciento de los pacientes presentarom complicaciones postoperatorias. El tiempo de hospitalización postoperatoria fue de 17,2 por ciento días en promedio, con un rango entre 9 y 36 días. Cuatro pacientes fallecieron en el postoperatorio (7,8 por ciento). Entre las complicaciones quirúrgicas destacan 4 fístulas de la anastomosis esofagoyeyunal (7,8 por ciento) y 4 abscesos subfrénicos (7,8 por ciento). La sobrevida a un año, 2 y 3 años fue de 52 por ciento, 20 por ciento y 0 por ciento, respectivamente. La sobrevida media fue de 4,7 meses ( rango: 3-34 meses). La resección tumoral es el mejor tratamiento en pacientes que clínicamente se encuentran en estadio IV. La gastrectomía total mejora la calidad de vida en estos pacientes

Variación de la glicemia durante el test de tolerancia a la glucosa según el anticoagulante utilizado y su repercusión en el diagnóstico de diabetes gestacional / Variation of glicemia during glucose tolerance test depending on anticoagulant utilization and it repercussion in pregnancy diabetes diagnosis

Cincuenta y siete embarazadas con glicemia 1 hora post 50 g de glucosa > a 140 mg/dl fueron sometidas a un test de tolerancia a la glucosa (TTG) oral con 100 g de glucosa. Con el objeto de investigar la influencia del anticoagulante usado en las muestras para glicemia, se toman dos alícuotas a las 0-1-2 y 3 horas, una con fluoruro de sodio y la otra con heparina, las que se almacenan para ser analizadas al final del test. Los promedio de todas las glicemias tomadas con heparina fueron menores, debido a que este anticoagulante no inhibe la glucólisis como el fluoruro. Esto es especialmente importante en los TTG negativos con glicemias límites pues podría tratarse de falsos negativos. Se obtuvo 8 TTG positivos con fluoruro y 5 con heparina (37,5 por ciento de subdiagnóstico). En una serie de 28 pacientes normales el valor de la glicemia basal fue disminuyendo a medida que pasaba el tiempo para ser procesada. A las 3 horas, el nivel de glucosa bajó 16,9 por ciento en muestras con heparina y 6,7 por ciento con fluoruro (p < 0,01)

Manifestaciones otorrinolaringológicas de las enfermedades granulomatosas: Experiencia en el Hospital Universitario de Caracas, Venezuela / Otorhinolaryngologic manifestation of granulomatose diseases: Experience at Hospital Universitario de Caracas, Venezuela

Las enfermedades granulomatosas representan un grupo heterogeneo de afecciones de evolucion cronica, caracterizadas por su tendencia a persistir y a progresar. En la esfera otorrinolaringologica, causan lesiones mucosas granulomatosas necrotizantes, que se manifiestan por un variado espectro de formas clinicas, afectando todos los organos del tracto respiratorio superior, ocasionando graves defectos anatomicos y severos trastornos funcionales. En el Servicio de Otorrinolaringologia del Hospital Universitario de Caracas se presentan con mayor frecuencia la tuberculosis, leishmaniasis, paracoccidioidomicosis e histoplasmosis. Se realiza una revision de las manifestaciones clinicas más frecuentes y se hacen consideraciones diagnosticas, ya que son enfermedades que requieren un alto indice de sospecha y representan un reto a la terapeutica otorrinolaringologica, debido a lo prolongado, costoso y mal tolerado del tratamiento, asi como por la tendencia natural a recidivar

Meningoencefalitis virales por Enterovirus en Cuba en el período 1990-1995 / Viral meningoencephalities due to enteroviruses in Cuba during 1990-1995

Se describen los resultados del estudio de enterovirus como agentes causanes de meningoencefalitis viral (MEV) en Cuba, desde 1990 hasta 1995. En este período fueron estudiados 586 muestras de heces, 108 líquidos cefalorraquídeos y 1095 sueros pareados para un total de 1789 muestras, procedentes de 1458 pacientes diagnosticados clínicamente con esta patología. Las muestras para el aislamiento viral se inocularon en dos sistemas celulares diferentes, encontrándose 225 muestras positivas a enterovirus que representan el 32,42 o/o del total; el mayor número de aislamientos (217) fue a partir de heces, en células diploides de fibroblastos de pulmón humano (PHuE-1). Las determinaciones de anticuerpos se realizaron por prueba de neutralizacion en micrométodo, enfrentándolos con 10 antígenos de enterovirus (Echovirus 4, 6, 9, 11 y Coxsackievirus B1-6) y, en períodos epidémicos, además con el virus aislado. En los años estudiados se produjeron tres brotes epidémicos por Coxsackievirus A9 (1990-91), Echovirus 30 (1994) y Coxsackievirus B5 (1995). Es de señalar que desde 1970 los Coxsackievirus A9 y Echovirus 30 se vincularon en nuestro país, por primera vez, con epidemias de MEV. En los sueros pareados se obtuvo 66,84 o/o de positivos, siendo la mayor positividad a los Echovirus 6 y 11. Al considerar en conjunto la positividad por aislamiento y serología, más del 80 o/o de los casos estudiados pudieran tener ua explicación por algún enterovirus, lo uqe demuestra la importancia de estos agentes como causantes de MEV en Cuba

Desproporción congénita del tipo de fibra muscular: primeros casos nacionales / Congenital muscle fiber-type disproportion: first national cases

La Desproporción Congénita del Tipo de Fibra Muscular (DCTFM) es una miopatía congénita cuyo patrón histopatológico se caracteriza, como principal alteración demostrable, por el menor diámetro de las fibras tipo I con respecto al tamaño de las fibras tipo II. Clínicamente se presenta, al igual que otras miopatías congénitas, por hipotonía presente en la mayoría de los casos desde el nacimiento y retraso en la adquisición de las conductas motoras. La evolución puede ser benigna, para estabilizarse o mejorar con el desarrollo, o ser causa de muerte en la infancia. En este trabajo se presentan los dos primeros casos de DCTFM diagnosticados en nuestro medio. Se destaca que en las miopatías congénitas la presentación clínica es similar y que las diferentes entidades se definen exclusivamente por los hallazgos histopatológicos, si bien los mismos dependen del procesamiento selectivo de la biopsia muscular por un equipo especializado

La biopsia muscular en las miopatías inflamatorias idiopáticas / Muscular biopsy in idiopathic inflammatory myopathies

En el presente trabajo se realiza una actualización sobre los hallazgos histopatológicos en la biopsia muscular de las miopatías inflamatorias idiopáticas, en función de los recientes conceptos de etiopatogenia de la dermatomiositis y polimiositis, tomando como punto de partida los casos diagnosticados en un período de 3 años y medio por nuestro equipo. Se destaca el valor de la biopsia muscular para confirmar la afectación muscular, excluir otras enfermedades neuromusculares y definir el diagnóstico de miopatía inflamatoria