Reduction of peritoneal adhesion to polypropylene mesh with the application of fibrin glue.

PURPOSE: The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue. METHODS: Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount. RESULTS: Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006). CONCLUSIONS: Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

Update in internal medicine.

More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.

[Breath tests as a noninvasive diagnostic method in Helicobacter pylori infection]. / La prueba de aliento como método diagnóstico no invasivo en la infección por Helicobacter pylori.

There are several diagnostic methods for Helicobacter pylori infection, some of them need an endoscopic procedure and biopsy to be performed (invasive) like the rapid urease test, culture and histology. Recently non invasive, specific, sensible, easy to perform and patient's well accepted methods had been developed known as breath test, based on the hydrolysis of labelled urea by Helicobacter pylori urease enzyme, to release ammonia and bicarbonate. Labelled CO2 reaches the bloodstream and the lungs, from where can be collected into the breath for quantification. Labelled urea has to options: 13C stable, non-radioactive and 14C unstable, radioactive. Breath test with 13C is based on the atomic mass difference between 12C and 13C and it is necessary a mass spectrometer and 40 minutes to perform it. Breath test with 14C has 1 uCi (one micro-curie) of radioactivity (1/300 of total radiation received in one year from the environment); the test takes 10 minutes and the samples are read in a beta counter. Both non-invasive tests had demonstrated sensitivity and specificity comparable to established "gold standards" for Helicobacter pylori infection diagnosis.

[Malnutrition and total parenteral nutrition: a cohort study to determine the incidence of refeeding syndrome]. / Desnutrición y nutrición parenteral total: estudio de una cohorte para determinar la incidencia del síndrome de realimentación.

UNLABELLED: The Refeeding Syndrome is conformed by a series of clinical manifestations related to electrolytic alterations associated with the restarting of the nutritive contribution both enteral and parenteral. AIM: To detect the Refeeding Syndrome incidence in malnourished patients who required nutritional, enteral or endovenous support and its relationship with mortality. MATERIAL AND METHODS: A cohort study was performed in the service of Nutritional Support of the IMSS (Social Security Mexican Institute) Specialties Hospital CMN León, from June 1995 to May 1996. All patients with mild and severe malnutrition were included, they received endovenous or enteral nutritious support for more than 7 days, without presenting previous electrolytic unbalance. Serum potassium, phosphorous, and magnesium levels were determined before starting the nutritious support and also on the 3rd, 7th, and 10th days. Descriptive statistics, Student's t and Z test were used, with a 5% significance level. RESULTS: 148 patients with total nutritional support, 23 (16%) of them with restrained malnutrition and 65 (44%) with severe deficit. 54 men and 34 women with an average age of 51.6 +/- 19.4 years. Nineteen patients were eliminated due to a nutrition period of less than 7 days, and other 19 were also eliminated for presenting electrolytic alterations before the nutritive support started. An incidence of 48% of electrolytic alterations compatible with the refeeding syndrome was the result in the remaining 50 patients. The alterations were: hypomagnesemia 13/24, hypokalemia 12/24 and hypophosphatemia 4/24; in 55% of the cases the syndrome appeared at the third day of administration. Hospital sojourn of patients with the syndrome was 26.7 +/- 18 days vs 15.3 +/- 7 (p < 0.05) of those who did not present it. 15 patients died, 5 of them had electrolytic alterations before nutrition, 7 (29%) with refeeding syndrome and 3 (12%) did not presented it (p = 0.059). CONCLUSIONS: Refeeding Syndrome is a frequent entity in malnourished patients submitted to enteral or parenteral nutrition; at least in this study it was of 48%; its presence was followed by a longer hospital stay and a higher mortality rate.

[Diaphragmatic hernia caused by penetrating injury: emergency laparoscopic reconstruction]. / Hernia diafragmática por herida penetrante: plastia laparoscópica de urgencia.

OBJECTIVE: To inform a patient with penetrating thoracic trauma and diaphragm injury that produced stomach herniation, being reduced the hernia and repaired the injury by laparoscopy though abdominal route with excellent result. REPORT: 17-years-old male, hemodynamically stable with penetrating injury in the fifth left intercostal space, at the level of the middle auxiliary line, pneumothorax and left diaphragmatic hernia. Treatment. A pleurostomy tube was inserted. By laparoscopy 600 mL of free blood in abdominal cavity were aspired, the stomach hernia was reduced and the diaphragmatic repair was performed with nylon 3-0 running suture. The evolution was excellent, being integrated to his work at the twentieth postoperative day. COMMENTARY: Our case supports that laparoscopic surgery is at therapeutic alternative in select cases of trauma.

[Reflux esophagitis: a comparative study of lansoprazole and omeprazole as short-term therapy. Preliminary report]. / Esofagitis por reflujo: estudio comparativo entre lansoprazol y omeprazol como terapia a corto plazo, informe preliminar.

BACKGROUND: Reflux Esophagitis is a common complaint from the upper gastrointestinal tract with a figured out prevalence of about 2%. Therapeutic results in this pathology have been unsatisfactory. AIM: To compare lansoprazole and omeprazole therapeutic effects in patients with reflux esophagitis. MATERIALS AND METHODS: A clinical, double-blinded, balanced survey was randomly designed with patients who would daily receive 30 mg lansoprazole (Group A) or 20 mg omeprazole (Group B) during a 4-week period. All patients were submitted to endoscopy and biopsy both at the beginning and at the end of the survey. RESULTS: Ten patients in each group were treated without any significant differences in sex, age, nicotinism, alcoholism, AINES ingestion, development time, pain regurgitations, pyrrosis, hematemesis, dysphagia, melena, nausea or vomiting, and esophagitis degree. A complete cure in 8/10 (omeprazole) and 7/10 (lansoprazole) patients was obtained (p = n.s.). However, the histological results of the biopsy at the end of the four-week period proved to be a failure in 4/10 (omeprazole) and in 5/10 (lansoprazole) patients (p = n.s.). The endoscopy and clinical result at the end of the study were similarly effective; but not so the histological damage to the esophagus, which continues to be important. CONCLUSIONS: The use of bomb inhibitors in esophagitis by reflux is advisable. Future surveys must assess the average time of treatment for the disappearance of the histologic lesion.

[Treatment of enterocutaneous fistula with or without octreotide and parenteral nutrition]. / Tratamiento de las fístulas enterocutáneas con o sin octreótida y nutrición parenteral.

OBJECTIVE: To evaluate the use of octreotide together with the conservative handling in the treatment of patients with external gastrointestinal fistulae. MATERIAL AND METHODS: Clinical essay in postsurgical gastrointestinal fistulae carriers assisted during a 54-month period. They were randomly distributed in two groups: group A was treated with conventional handling and group B was additionally treated with octreotide. RESULTS: 44 women and 55 men with an average age of 50 +/- 19 years old were treated. The following table summarizes the result variables. [table: see text] CONCLUSION: The use of octreotide is recommendable, for it was useful in diminishing both the closing time of the fistula and the time the nutritional support the patient requires. Mortality still continues to be very increased (because of sepsis), by which the phrase "primum non nocere" takes a relevant place since this pathology is greatly preventable.

[Nutritional support in severe acute pancreatitis. Controlled clinical trial]. / Apoyo nutricional en pancreatitis aguda grave. Ensayo clínico controlado.

INTRODUCTION: Severe acute pancreatitis is an ailment with a higher than 60% mortality. The nutritional support is a fundamental part of the treatment in these patients with the aim of ameliorating traumatic metabolic response. AIM: To compare total effectiveness of parenteral nutrition and enteral nutrition through jejunostomy in postoperated patients for acute pancreatitis. MATERIAL AND METHODS: A clinically controlled, longitudinal, prospective, experimental and at random survey was performed with our hospital's nutritional supportive service (which is a reference center) in a 16-month period. Patients postoperated on for severe pancreatitis were included (3 or more of Ranson's criteria), the ones who died before the first week were excluded. Group I was treated with total parenteral nutrition, and group II with enteral nutrition via jejunostomy through a silicon catheter placed at transoperative. The result variables were summed up at the beginning and every week for a 3-week period. The hipotheses were contrasted with Student's " t " test with a tail for independent samples of a 5% significance level. RESULTS: Groups I and II were integrated by 12 and 10 patients respectively. Sex and ages were similar. Urine nitrogen was kept high in both groups, being group I the highest (ns). Nitrogen balance was kept close to neutrality in both groups (ns). Serum albumin levels were slightly increased in both groups (ns). The creatinine/size index showed loss of progressive muscular mass in both groups, being group II the lowest (p < 0,05). Total lymphocyte count depletion level improved from mild to normal in both groups, but being this more important in group II (p < 0,05). Global mortality was 40%. CONCLUSIONS: Enteral nutrition was as effective as parenteral in these patients, having the advantage of being less expensive, easier to handle and with a lesser rate of septic complications. We consider that this must be the nutritional method of choice if there are contra indications for its use.

[The incidence and opportunity for the diagnosis of diabetic retinopathy]. / Frecuencia y oportunidad del diagnóstico de retinopatía diabética.

This study aims to establish the frequency of diabetic retinopathy (DR) in patients with diabetes mellitus (DM) type II in Leon, Guanajuato, Mexico, as well as the opportunity for their diagnosis. A prospective study was carried out in a sample of 100 patients. DR was stratified using the classification of the Early Treatment Diabetic Retinopathy Study Research Group and diagnosed in 42 per cent of the sample. The evolution time of diabetes in this group was different from that of the group without RD (p < 0.0001). A direct proportional and significant relationship between the duration of DM and an increasing severity of DR was found. Opportune diagnosis was made in 70 per cent of the cases with DR. In 81 per cent of the 42 patients with DR, no previous diagnosis was made. This study shows a high proportion of RD without diagnosis. The intensification of educational strategies for the opportune detection and early treatment of DR is recommended.

[Diazepam versus midazolam as pre-endoscopic medication]. / Diazepam versus midazolam como medicación pre-endoscópica.

A prospective randomized double blind study was carried out on 60 patients undergoing elective gastrointestinal endoscopy. Patients in group A were sedated with diazepam (0.15 mg/kg) and those in group B received midazolam (0.10 mg/kg). There were no differences between the groups in age, sex, previous drug intake, level of anxiety prior to the procedure and from the endoscopist point of view the easiness to perform the studies. The group of patients who received midazolam (B) showed a significantly greater sedation, had less pain in the site of injection, their retrograde amnesia was more effective and tolerated much better the overall procedure (p < 0.05). There were no complications in either group. The cost per dosage was 2:1 greater with midazolam. It is concluded that midazolam has some advantages over diazepam used for sedation of patients undergoing gastrointestinal endoscopy. The time for recovery and cost are its disadvantages.

Cutaneous amebiasis of the face: a case report.

This paper describes a case of cutaneous amebiasis of the face in a 17-month-old girl. About four weeks prior to admission she had diarrhea with high suspicion of intestinal amebiasis. Fifteen days later she presented with edema of the right lower eyelid and epiphora. There was a vesicle in the inner angle of the eye which spontaneously drained, causing loss of the underlying tissue. The ulcer developed rapidly, destroying periorbital tissue. Both cytology and biopsy of the ulceration border showed abundant trophozoites of Entamoeba histolytica. Treatment was specific therapy and surgery.

Quiste torcido de ovario en una recien nacida. Informe de un caso. / Twisted ovarian cyst in a newborn infant. Report of a case

Se informa el caso de una recien nacida con quiste torcido en el ovario derecho y poliquistosis en el ovario izquierdo. Las manifestaciones clinicas fueron: ataque al estado general, oclusion intestinal y tumoracion abdominal, presentando dificultad en el diagnostico diferencial con estenosis intestinal y enterocolitis necrosante.Se trato medica y quirurgicamente con resultados satisfactorios.Se hace una correlacion clinicopatologica; se efectua una revision de la literatura haciendo referencia a las complicaciones que se presentan si el diagnostico es tardio

Endometriosis apendicular. Informe de un caso. / Apendicceal endometriosis.Report of a case

La endometriosis apendicular tiene una frecuencia menor de 1 por ciento de las endometriosis pelvicas. Su diagnostico en la mayor parte de las ocasiones es incidental. Se informa un caso de endometriosis apendicular en una mujer en la cuarta decada de la vida, con antecedentes de esterilidad primaria, que ingreso con cuadro doloroso abdominal en cuadrante inferior derecho sin otros datos clinicos, radiologicos e do laboratorio que sugirieran el diagnostico. Se intervino con diagnostico preoperatorio de apendicitis aguda y se el realizo apendicectomia. El estudio histopatologico demostro focos endometrioides en la serosa apendicular sin datos de apendicitis aguda. La endometriosis debe considerarse entre las posibilidades diagnosticas en mujeres con cuadros "apendiculares" en los dias premenstruales y menstruales

Quiste solitario gigante no parasitario de higado. Informe de un caso. / Solitary giant non-parasitic cyst of liver. Report of a case

Los quistes solitarios uniloculares no parasitarios de higado son poco frecuentes, de crecimiento lento y clinicamente silenciosos en la mayoria de los casos, y provocan arduos problemas de diagnostico. Se informa el caso de una mujer de 35 anos de edad quien presento como sintomatologia distension abdominal, dispepsia, ictericia leve, edema de miembros inferiores y disnea secundaria al aumento del perimetro abdominal. Habia sido tratada previamente como caso de cirrosis hepatica. Por medio de ecosonografia, gammagrafia y urografia excretora se establecio el diagnostico preoperatorio de quiste gigante unilocular de higado, el cual comprimia estomago duodeno, vias biliares extrahepaticas y vena cava. Se intervino quirurgicamente con extraccion de 7.800 litros de material liquido de retencion que, segun los informes existentes en la literatura nacional es el mas grande que se ha notificado. Se efectuo marsupializacion del quiste a pared abdominal, y la paciente permanece asintomatica hasta la fecha