Structural Behavior of Amphiphilic Triblock Copolymer P104/Water System.

A detailed study of the different structural transitions of the triblock copolymer PEO27-PPO61-PEO27 (P104) in water, in the dilute and semi-dilute regions, is addressed here as a function of temperature and P104 concentration (CP104) by mean of complimentary methods: viscosimetry, densimetry, dynamic light scattering, turbidimetry, polarized microscopy, and rheometry. The hydration profile was calculated through density and sound velocity measurements. It was possible to identify the regions where monomers exist, spherical micelle formation, elongated cylindrical micelles formation, clouding points, and liquid crystalline behavior. We report a partial phase diagram including information for P104 concentrations from 1 × 10-4 to 90 wt.% and temperatures from 20 to 75 °C that will be helpful for further interaction studies with hydrophobic molecules or active principles for drug delivery.

Leveling Up the Access to Radiation Therapy in Latin America: Economic Analysis of Investment, Equity, and Inclusion Opportunities Up to 2030.

PURPOSE: Latin America faces a shortage in radiation therapy (RT) units and qualified personnel for timely and high-quality treatment of patients with cancer. Investing in equitable and inclusive access to RT over the next decade would prevent thousands of deaths. Measuring the investment gap and payoff is necessary for stakeholder discussions and capacity planning efforts. METHODS AND MATERIALS: Data were collected from the International Atomic Energy Agency's Directory of Radiotherapy Centers, industry stakeholders, and individual surveys sent to national scientific societies. Nationwide data on available devices and personnel were compiled. The 10 most common cancers in 2020 with RT indication and their respective incidence rates were considered for gap calculations. The gross 2-year financial return on investment was calculated based on an average monthly salary across Latin America. A 10-year cost projection was calculated according to the estimated population dynamics for the period until 2030. RESULTS: Eleven countries were included in the study, accounting for 557,213,447 people in 2020 and 561 RT facilities. Approximately 1,065,684 new cancer cases were diagnosed, and a mean density of 768,469 (standard deviation ±392,778) people per available unit was found. By projecting the currently available treatment fractions to determine those required in 2030, it was found that 62.3% and 130.8% increases in external beam RT and brachytherapy units are needed from the baseline, respectively. An overall regional investment of approximately United States (US) $349,650,480 in 2020 would have covered the existing demand. An investment of US $872,889,949 will be necessary by 2030, with the expectation of a 2-year posttreatment gross return on investment of more than US $2.1 billion from patients treated in 2030 only. CONCLUSIONS: Investment in RT services is lagging in Latin America in terms of the population's needs. An accelerated outlay could save additional lives during the next decade, create a self-sustaining system, and reduce region-wide inequities in cancer care access. Cash flow analyses are warranted to tailor precise national-level intervention strategies.

Development of functional hybrid scaffolds for wound healing applications.

Hybrid hydrogels composed of chitosan (CS) and hyaluronic acid (HA) and collagen (Coll) were prepared by polyelectrolyte complex self-assembly. These scaffolds displayed a good intermingling of the polymeric chains, with porosities above 80% and good interconnected structures with pore sizes lying between 30-115 µm. The ionic interactions between CS and HA make the scaffolds have larger storage modulus and longer LVR regions than their pure counterparts. Both quantities progressively decrease as the HA and Coll concentrations in the formulation rise. These hybrid hydrogels showed good swelling extents from ca. 420 to ca. 690% and suitable resistance to enzymatic degradation, which was slightly lower for scaffolds containing CS to larger extents or Coll in the formulation. All scaffolds were largely cytocompatible and allowed the proliferation of both mouse fibroblast and human keratinocytes with their infiltration inside, thus becoming optimal matrices for intended tissue engineering applications as well as transdermal drug delivery depots.

Optimization of the Obtaining of Cellulose Nanocrystals from Agave tequilana Weber Var. Azul Bagasse by Acid Hydrolysis.

A multilevel factorial design of 23 with 12 experiments was developed for the preparation of cellulose nanocrystals (CNC) from Agave tequilana Weber var. Azul bagasse, an agro-industrial waste from tequila production. The studied parameters were acid type (H2SO4 and HCl), acid concentration (60 and 65 wt% for H2SO4, 2 and 8N for HCl) temperature (40 and 60 °C for H2SO4, 50 and 90 °C for HCl), and hydrolysis time (40, 55 and 70 min for H2SO4; and 30, 115 and 200 min for HCl). The obtained CNC were physical and chemically characterized using dynamic light scattering (DLS), atomic force microscopy (AFM), Fourier-transform infrared spectroscopy (FT-IR), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XDR) techniques. The maximum CNC yield was 90 and 96% for HCL and H2SO4, respectively, and the crystallinity values ranged from 88-91%. The size and morphology of A. tequilana CNC strongly depends on the acid type and hydrolysis time. The shortest CNC obtained with H2SO4 (65 wt%, 40 °C, and 70 min) had a length of 137 ± 68 nm, width 33 ± 7 nm, and height 9.1 nm, whereas the shortest CNC obtained with HCl (2 N, 50 °C and 30 min) had a length of 216 ± 73 nm, width 69 ± 17 nm, and height 8.9 nm. In general, the obtained CNC had an ellipsoidal shape, whereas CNC prepared from H2SO4 were shorter and thinner than those obtained with HCl. The total sulfate group content of CNC obtained with H2SO4 increased with time, temperature, and acid concentration, exhibiting an exponential behavior of CSG=aebt.

Production of Chitosan/Hyaluronan Complex Nanofibers. Characterization and Physical Properties as a Function of the Composition.

In this work, optimized conditions for preparation of chitosan and hyaluronan polyelectrolyte complex are proposed. The objective was to produce new biomaterials being biocompatible and bioresorbable in the body as well as approaching the extracellular matrix (ECM) structure. These materials will be tested for chondrocyte development in tissue engineering and wound healing applications. Nanofibers made of the polyelectrolyte complex (PEC) were successfully manufactured by electrospinning, and casted films were used as a model for properties comparison. To our knowledge, it is the first time that stable chitosan/hyaluronan fibers are produced, which were observed to be long-lasting in buffer at pH~7.4. The role of thermal treatment at 120 °C for 4 h is examined to control the degree of swelling by crosslinking of the two polysaccharides by H-bonds and amide bonds formation. The properties of the materials are tested for different PEC compositions at different pH values, based on swelling and solubility degrees, diameters of nanofibers and mechanical performances. The influence of the solvent (acidic potential and composition) utilized to process biomaterials is also examined. Acid formic/water 50/50 v/v is observed to be the more appropriated solvent for the carried-out procedures.

Oil-in-eutectic mixture HIPEs co-stabilized with surfactant and nanohydroxyapatite: ring-opening polymerization for nanocomposite scaffold synthesis.

Mixtures of a nonionic surfactant and non-functionalized nanohydroxyapatite (NHA) enhanced the stability of oil-in-eutectic mixture high internal phase emulsions (HIPEs). Upon ring opening polymerization of the eutectic mixture composed of l-lactide and ε-caprolactone, biodegradable polyHIPEs with specific cavity sizes and selective interfacial functionalization with NHA are produced.

Modulated volumetric arc therapy for total marrow irradiation: A feasibility study in the oncology hospital of CMN SXXI from a medical physics approach.

AIM: The objective of this study is to explore the use of volumetric arc therapy (VMAT) to perform total marrow irradiation (TMI) and compare its results to the standard TBI technique in the Mexican public health system. BACKGROUND: The standard total body irradiation (TBI) technique is used with chemotherapy as a method of a pre-transplant conditioning of the bone marrow. In this technique, the whole body of the patient is considered to be PTV and irradiated generating toxicities and raising concerns about possible development of radio-induced tumors. MATERIALS AND METHODS: Through the use of simulation tomography of 12 patients previously treated with TBI, twelve different treatment plans were created with the proposed TMI technique and compared with the conventional protocol, the treatment plans were evaluated with a dose volume histogram analysis and quality assurance was evaluated with a portal dosimetry system using the gamma index criteria 3%/3 mm. RESULTS: Experimental results show an increasing dose to 99% of PTV of up to 41.1% by using TMI with the VMAT technique. The mean average dose to PTV was increased up to 19.3%. The use of the new TMI technique caused an improvement in the mean average dose to 99% of the PTV as well the homogeneity of the dose distribution prescribed at the PTV while leading to a better reproducibility of the treatment. The Qa of all the plans met the criterion of gamma index 3 mm-3%. CONCLUSION: The results analysis shows that the proposed TMI technique is feasible and applicable in the Mexican public health system.

Biomaterials Based on Electrospun Chitosan. Relation between Processing Conditions and Mechanical Properties.

In this paper, it is shown that pure chitosan nanofibers and films were prepared with success in 0.5 M acetic acid as solvent using poly (ethylene oxide) (PEO) at different yields, allowing electrospinning of the blends. After processing, a neutralization step of chitosan followed by water washing is performed, preserving the initial morphology of chitosan materials. The influence of the yield in PEO in the blend on the degree of swelling and hydrophilicity of films and nanofibers is demonstrated. Then, the mechanical behavior of blended nanofibers and films used as reference are determined for small stress applied in the linear domain by DMA and by uniaxial traction up to rupture. The dried and wet states are covered for the first time. It is shown that the mechanical properties are increased when electrospinning is performed in the presence of PEO up to a 70/30 chitosan/PEO weight ratio even after PEO extraction. This result can be explained by a better dispersion of the chitosan in the presence of PEO.

Role of Electrostatic Interactions on Supramolecular Organization in Calf-Thymus DNA Solutions under Flow.

Previous investigations were conducted on two concentrations of DNA solution: 4 mg/mL, for which it has been shown that no supramolecular organization is induced under flow at low shear rates; and 10 mg/mL, in which a liquid crystalline-type texture is formed under flow at low shear rates, attesting to an orientation of pre-organized chains. Rheological experiments are discussed and their results supported by small-angle X-ray scattering (SAXS) and flow birefringence visualization experiments. Scattering from polyelectrolytes has a characteristic signal, which is here observed in SAXS, showing a strong correlation peak between charged chains in water, for both concentrations. This peak is weaker in the presence of 0.01 M NaCl and suppressed in salt excess at 0.1 M NaCl. No plateau in the σ( γ ˙ ) plot was observed in analysis of rheological experiments on low DNA concentration (4 mg/mL). As typically observed in polyelectrolyte systems both the dynamic moduli and shear viscosity were higher in water as electrostatic forces dominate, than in the presence of salt, especially at low shear rates. The rheological results for concentrations of 0.01 M NaCl are lower than in water as expected due to partial screening of electrostatic repulsions. Rheological data for concentrations of 0.1 M NaCl are unexpected. Electrostatic forces are partially screened in the low salt concentration, leading to a drop in the rheological values. For high salt concentration there are no longer interchain repulsions and so steric interactions dominate within the entangled network leading to the subsequent increase in rheological parameters. Regardless of the solvent, at high shear rates the solutions are birefringent. In the 10 mg/mL case, under flow, textures are formed at relatively low shear rate before all the chains align going to a pseudonematic liquid crystalline phase at high shear rate. The electrostatic repulsion between semi-rigid chains induces a correlation between the chains leading to an electrostatic pseudo-gel in water and loosely in 0.01 M NaCl at low stress applied. To the best of our knowledge, this is the first time that such behavior is observed. In 0.1 M NaCl, DNA behavior resembles the corresponding neutral polymer as expected for polyelectrolyte in salt excess, exhibiting a yield stress. When texture appears in water and in 0.01 M NaCl, a critical transition is observed in rheological curves, where the viscosity decreases sharply at a given critical shear stress corresponding to a plateau in the σ( γ ˙ ) plot also observed in creep transient experiment.

Rheological Properties of DNA Molecules in Solution: Molecular Weight and Entanglement Influences.

Molecular weight, stiffness, temperature, and polymer and ionic concentrations are known to widely influence the viscosity of polymer solutions. Additionally, polymer molecular weight-which is related to its dimensions in solution-is one of its most important characteristics. In this communication, low molecular weight DNA from salmon sperm was purified and then studied in solutions in a wide concentration range (between 0.5 and 1600 mg/mL). The intrinsic viscosity of this low molecular weight DNA sample was firstly determined and the evidence of the overlap concentration was detected around the concentration of 125 mg/mL. The chain characteristics of these short molecules were studied in terms of the influence of their molecular weight on the solution viscosities and on the overlap parameter CDNA[η]. Furthermore, to complete previously reported experimental data, solutions of a large molecular weight DNA from calf-thymus were studied in a high concentration range (up to 40 mg/mL). The rheological behavior is discussed in terms of the generalized master curve obtained from the variation of the specific viscosity at zero shear rate (ηsp,0) as a function of CDNA[η].

Conformation and Rheological Properties of Calf-Thymus DNA in Solution.

Studies of DNA molecule behavior in aqueous solutions performed through different approaches allow assessment of the solute-solvent interactions and examination of the strong influence of conformation on its physicochemical properties, in the presence of different ionic species and ionic concentrations. Firstly, the conformational behavior of calf-thymus DNA molecules in TE buffer solution is presented as a function of temperature. Secondly, their rheological behavior is discussed, as well as the evidence of the critical concentrations, i.e., the overlap and the entanglement concentrations (C* and Ce, respectively) from steady state flow and oscillatory dynamic shear experiments. The determination of the viscosity in the Newtonian plateau obtained from flow curves η ( ) allows estimation of the intrinsic viscosity and the specific viscosities at zero shear when C[η] < 40. At end, a generalized master curve is obtained from the variation of the specific viscosity as a function of the overlap parameter C[η]. The variation of the exponent s obtained from the power law η~ -s for both flow and dynamic results is discussed in terms of Graessley's analysis. In the semi-dilute regime with entanglements, a dynamic master curve is obtained as a function of DNA concentration (CDNA > 2.0 mg/mL) and temperature (10 °C < T < 40 °C).

Heridas de la región toracoabdominal / Wounds in the thoracoabdominal region

Introducción: los traumatismos penetrantes en la región toracoabdominal presentan un variado espectro de lesiones. El cirujano debe ser capaz de diagnosticar y tratar de forma emergente lesiones de órganos situados en dos cavidades de forma simultánea, e identificar cuál de ellas compromete la vida más rápidamente. Objetivo: caracterizar a los pacientes con herida en la región toracoabdominal. Métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el centro de urgencias del Hospital Militar Central Dr. Carlos J. Finlay. Se analizaron 63 lesionados con diagnóstico de herida toracoabdominal desde enero de 2007 a enero de 2009. Se tuvieron en cuenta las variables: sexo, edad, agente vulnerante, lesiones más frecuentes, así como los procedimientos quirúrgicos realizados. Resultados: predominó el sexo masculino en relación de 4 a 1 y el grupo de edad entre 21 y 30 años. El 84 por ciento de las lesiones fueron ocasionadas por arma blanca. Más de la mitad de los lesionados tenían lesiones en ambas cavidades. El órgano más afectado en el tórax fue el pulmón y en el abdomen el hígado. Los procedimientos quirúrgicos más utilizados fueron la pleurostomía mínima indiferente y la laparotomía exploradora en el 60 por ciento de los casos. La mortalidad fue de 6,4 por ciento y se debió fundamentalmente al shock hipovolémico severo. Conclusiones: los pacientes se caracterizaron por ser fundamentalmente hombres, jóvenes con heridas por arma blanca con afectación pulmonar o hepática que requieren realizar laparotomía exploratoria y tratamiento inmediato del shock hipovolémico

Introduction: the penetrating traumata in thoracoabdominal region have a varied lesions spectrum. Surgeon must to be able of to diagnose and to treat in an emergent way the lesions of organs located in two cavities at the same time, and to identify which of them compromise faster the life. Objective: to characterize patients with wounds in thoracoabdominal region. Methods: a retrospective, descriptive and observational study was conducted at the center of urgencies of the "Dr. Carlos J. Finlay" Central Military Hospital. Sixty three patients were analyzed diagnosed with thoracoabdominal wound from January, 2007 to January, 2009. Authors took into account the following variables: sex, age, vulnerant agent, more frequent lesions, as well as the surgical procedures carried out. Results: there was predominance of male sex in a 4:1 ratio and in the 21 and 30 age-groups. The 84 percent of lesions were provoked by blade. More than the half of injured had lesions in both cavities. The more involved organ was the lung and in the abdomen region it was the liver. The more used surgical procedures were an indifferent minimal pleurotomy and the exploratory laparotomy in the 60 percent of cases. Mortality was of 6.4 percent mainly due to severe hypovolemic shock. Conclusions: patients were mostly by young men with wounds by blade and pulmonary or hepatic involvement requiring exploratory laparotomy and immediate treatment of hypovolemic shock

Heridas de la región toracoabdominal / Wounds in the thoracoabdominal region

Introducción: los traumatismos penetrantes en la región toracoabdominal presentan un variado espectro de lesiones. El cirujano debe ser capaz de diagnosticar y tratar de forma emergente lesiones de órganos situados en dos cavidades de forma simultánea, e identificar cuál de ellas compromete la vida más rápidamente. Objetivo: caracterizar a los pacientes con herida en la región toracoabdominal. Métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el centro de urgencias del Hospital Militar Central Dr. Carlos J. Finlay. Se analizaron 63 lesionados con diagnóstico de herida toracoabdominal desde enero de 2007 a enero de 2009. Se tuvieron en cuenta las variables: sexo, edad, agente vulnerante, lesiones más frecuentes, así como los procedimientos quirúrgicos realizados. Resultados: predominó el sexo masculino en relación de 4 a 1 y el grupo de edad entre 21 y 30 años. El 84 por ciento de las lesiones fueron ocasionadas por arma blanca. Más de la mitad de los lesionados tenían lesiones en ambas cavidades. El órgano más afectado en el tórax fue el pulmón y en el abdomen el hígado. Los procedimientos quirúrgicos más utilizados fueron la pleurostomía mínima indiferente y la laparotomía exploradora en el 60 por ciento de los casos. La mortalidad fue de 6,4 por ciento y se debió fundamentalmente al shock hipovolémico severo. Conclusiones: los pacientes se caracterizaron por ser fundamentalmente hombres, jóvenes con heridas por arma blanca con afectación pulmonar o hepática que requieren realizar laparotomía exploratoria y tratamiento inmediato del shock hipovolémico(AU)

Introduction: the penetrating traumata in thoracoabdominal region have a varied lesions spectrum. Surgeon must to be able of to diagnose and to treat in an emergent way the lesions of organs located in two cavities at the same time, and to identify which of them compromise faster the life. Objective: to characterize patients with wounds in thoracoabdominal region. Methods: a retrospective, descriptive and observational study was conducted at the center of urgencies of the Dr. Carlos J. Finlay Central Military Hospital. Sixty three patients were analyzed diagnosed with thoracoabdominal wound from January, 2007 to January, 2009. Authors took into account the following variables: sex, age, vulnerant agent, more frequent lesions, as well as the surgical procedures carried out. Results: there was predominance of male sex in a 4:1 ratio and in the 21 and 30 age-groups. The 84 percent of lesions were provoked by blade. More than the half of injured had lesions in both cavities. The more involved organ was the lung and in the abdomen region it was the liver. The more used surgical procedures were an indifferent minimal pleurotomy and the exploratory laparotomy in the 60 percent of cases. Mortality was of 6.4 percent mainly due to severe hypovolemic shock. Conclusions: patients were mostly by young men with wounds by blade and pulmonary or hepatic involvement requiring exploratory laparotomy and immediate treatment of hypovolemic shock(AU)

Comportamiento de la úlcera gastroduodenal perforada / Behavior of the perforated gastroduodenal ulcer

INTRODUCCIÓN: la úlcera gastroduodenal perforada continúa siendo un problema importante para el cirujano. OBJETIVO: caracterizar a los pacientes con úlceras gastroduodenales perforadas en un periodo de 4 años. MÉTODOS: se realizó un estudio descriptivo y retrospectivo en el Hospital Militar Central Dr. Carlos J. Finlay. Se seleccionaron 140 historias clínicas de pacientes a quienes se les efectuó intervención quirúrgica urgente por presentar úlcera gastroduodenal perforada, desde enero de 2004 a diciembre de 2008. Las variables recogidas fueron: edad, sexo, ocupación, localización de las perforaciones, hábitos tóxicos, procederes quirúrgicos empleados y complicaciones posoperatorias. RESULTADOS: predominó el grupo de edad de 51 a 60 años, la ocupación obrera y el sexo masculino. Las perforaciones duodenales fueron las más frecuentes. El tabaquismo, consumo de café y alcoholismo se consideraron los hábitos tóxicos predominantes en los pacientes. El proceder quirúrgico más empleado fue la sutura y epiploplastia. La sepsis de la herida quirúrgica y la peritonitis resultaron ser las complicaciones más frecuentes. CONCLUSIONES: Los pacientes atendidos por úlcera gastroduodenal perforada correspondieron fundamentalmente al sexo masculino, mayores de 50 años de edad con úlcera duodenal y consumidores de café, tabaco, alcohol, y fueron tratados con sutura y epiploplastia

INTRODUCTION: the perforated gastroduodenal ulcer remains as a significant problem for surgeon. OBJECTIVE: to characterize the patients presenting with perforated gastroduodenal ulcers over four years. METHODS: a retrospective and descriptive study was conducted in the Dr. Carlos J. Finlay Central Military Hospital. A total of 140 medical records were selected from patients underwent an urgent surgical intervention due to perforated gastroduodenal ulcer from January, 2004 to December, 2008. Variables included were: age, sex, occupation, perforations locations, toxic habits, surgical procedures used and postoperative complications. RESULTS: there was predominance of 51 to 60 age group, occupation and male sex. The more frequent were the duodenal perforations. Smoking, coffee habits and alcoholism were the predominant toxic habits in patients. The more used surgical procedure was the suture and epiploplasty. The surgical wound sepsis and the peritonitis were the more frequent complications

Íleo biliar / Biliary ileus

La litiasis vesicular es una entidad nosológica de frecuente ingreso y complicaciones, por lo cual el tratamiento médico-quirúrgico resulta frecuente en todos los servicios quirúrgicos. Una grave complicación de la litiasis vesicular la constituye el íleo biliar, entidad relativamente poco frecuente, caracterizada por un cuadro de obstrucción mecánica del intestino delgado o del colon, como consecuencia del paso de uno o más cálculos a través de una fístula biliodigestiva. Es una enfermedad caracteristica de la edad avanzada, con una edad promedio de 64 años y poco habitual antes de los 50 años. Se presenta el caso de una paciente del sexo femenino de 50 años de edad con un cuadro de obstrucción intestinal mecánica por cálculo biliar que ocluye la luz del íleon terminal, a nivel de los 40 cm proximales a la válvula de Bahuin, a quien no se le efectuó preoperatorio. Se realizó enterolitotomía y colecistectomía con fistulectomía y duodenorrafia. La paciente evolucionó favorablemente. Se concluye que es un caso característico de esta infrecuente afección y que el enfoque diagnóstico y terapéutico utilizado garantizó una evolución satisfactoria de la paciente

Vesicular lithiasis is a disease entity leads to frequent admissions and complications, thus, the medical-surgical treatment is usual in all surgical services. A severe complication of vesicular lithiasis is the infrequent biliary ileus characterized by a picture of mechanical obstruction of small bowel or the colon due to the passing of one or more calculi through a biliary-digestive fistula. It is disease characteristic of old age, with a mean age of 64 years and unusual before 50 years. This is the case of a female patient aged 50 with a picture of mechanical intestinal obstruction due to biliary calculus occluding the lumen of terminal ileum at the proximal 40 cm to Bahuin valve without preoperative diagnosis. An enterolithotomy and cholecystectomy were carried out with fistulectomy and duodenorrhaphy. Patient's course was favorable. We conclude that it a case characteristic of this infrequent affection and that the diagnostic and therapeutic approach used guaranteed a satisfactory course of the patient

Comportamiento de la úlcera gastroduodenal perforada / Behavior of the perforated gastroduodenal ulcer

INTRODUCCIÓN: la úlcera gastroduodenal perforada continúa siendo un problema importante para el cirujano. OBJETIVO: caracterizar a los pacientes con úlceras gastroduodenales perforadas en un periodo de 4 años. MÉTODOS: se realizó un estudio descriptivo y retrospectivo en el Hospital Militar Central Dr. Carlos J. Finlay. Se seleccionaron 140 historias clínicas de pacientes a quienes se les efectuó intervención quirúrgica urgente por presentar úlcera gastroduodenal perforada, desde enero de 2004 a diciembre de 2008. Las variables recogidas fueron: edad, sexo, ocupación, localización de las perforaciones, hábitos tóxicos, procederes quirúrgicos empleados y complicaciones posoperatorias. RESULTADOS: predominó el grupo de edad de 51 a 60 años, la ocupación obrera y el sexo masculino. Las perforaciones duodenales fueron las más frecuentes. El tabaquismo, consumo de café y alcoholismo se consideraron los hábitos tóxicos predominantes en los pacientes. El proceder quirúrgico más empleado fue la sutura y epiploplastia. La sepsis de la herida quirúrgica y la peritonitis resultaron ser las complicaciones más frecuentes. CONCLUSIONES: Los pacientes atendidos por úlcera gastroduodenal perforada correspondieron fundamentalmente al sexo masculino, mayores de 50 años de edad con úlcera duodenal y consumidores de café, tabaco, alcohol, y fueron tratados con sutura y epiploplastia(AU)

INTRODUCTION: the perforated gastroduodenal ulcer remains as a significant problem for surgeon. OBJECTIVE: to characterize the patients presenting with perforated gastroduodenal ulcers over four years. METHODS: a retrospective and descriptive study was conducted in the Dr. Carlos J. Finlay Central Military Hospital. A total of 140 medical records were selected from patients underwent an urgent surgical intervention due to perforated gastroduodenal ulcer from January, 2004 to December, 2008. Variables included were: age, sex, occupation, perforations locations, toxic habits, surgical procedures used and postoperative complications. RESULTS: there was predominance of 51 to 60 age group, occupation and male sex. The more frequent were the duodenal perforations. Smoking, coffee habits and alcoholism were the predominant toxic habits in patients. The more used surgical procedure was the suture and epiploplasty. The surgical wound sepsis and the peritonitis were the more frequent complications(AU)

Íleo biliar / Biliary ileus

La litiasis vesicular es una entidad nosológica de frecuente ingreso y complicaciones, por lo cual el tratamiento médico-quirúrgico resulta frecuente en todos los servicios quirúrgicos. Una grave complicación de la litiasis vesicular la constituye el íleo biliar, entidad relativamente poco frecuente, caracterizada por un cuadro de obstrucción mecánica del intestino delgado o del colon, como consecuencia del paso de uno o más cálculos a través de una fístula biliodigestiva. Es una enfermedad caracteristica de la edad avanzada, con una edad promedio de 64 años y poco habitual antes de los 50 años. Se presenta el caso de una paciente del sexo femenino de 50 años de edad con un cuadro de obstrucción intestinal mecánica por cálculo biliar que ocluye la luz del íleon terminal, a nivel de los 40 cm proximales a la válvula de Bahuin, a quien no se le efectuó preoperatorio. Se realizó enterolitotomía y colecistectomía con fistulectomía y duodenorrafia. La paciente evolucionó favorablemente. Se concluye que es un caso característico de esta infrecuente afección y que el enfoque diagnóstico y terapéutico utilizado garantizó una evolución satisfactoria de la paciente(AU)

Vesicular lithiasis is a disease entity leads to frequent admissions and complications, thus, the medical-surgical treatment is usual in all surgical services. A severe complication of vesicular lithiasis is the infrequent biliary ileus characterized by a picture of mechanical obstruction of small bowel or the colon due to the passing of one or more calculi through a biliary-digestive fistula. It is disease characteristic of old age, with a mean age of 64 years and unusual before 50 years. This is the case of a female patient aged 50 with a picture of mechanical intestinal obstruction due to biliary calculus occluding the lumen of terminal ileum at the proximal 40 cm to Bahuin valve without preoperative diagnosis. An enterolithotomy and cholecystectomy were carried out with fistulectomy and duodenorrhaphy. Patient's course was favorable. We conclude that it a case characteristic of this infrequent affection and that the diagnostic and therapeutic approach used guaranteed a satisfactory course of the patient(AU)

Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México / Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5) and in four cases with use of native tissues only (36.4); nine neonates survived (81.8), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

[Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico]. / Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México.

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5%) and in four cases with use of native tissues only (36.4%); nine neonates survived (81.8%), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.