Valoración manométrica del esófago de pacientes operados de acalasia mediante cirugía laparoscópica / Manometric assessment of the esophagus in patients operated on of achalasia by laparoscopic surgery

La acalasia esofágica es un trastorno motor primario con ausencia de peristaltismo e incapacidad de relajación del esfínter esofágico inferior. El presente estudio tuvo como objetivo comparar la evolución clínica y las características manométricas del esófago de pacientes con acalasia esofágica, antes y después cirugía laparoscópica. Se realizó un estudio prospectivo descriptivo con 17 pacientes (6 del sexo masculino y 11 del femenino), con edad comprendida entre 38 y 70 años y diagnóstico radiológico y endoscópico de acalasia esofágica, confirmado por estudio manométrico. Posteriormente, estos pacientes fueron sometidos a tratamiento quirúrgico, mediante esofagocardiomiotomía de Heller con funduplicatura antirreflujo de Dor o Toupet, por videolaparoscopia de forma aleatoria. A todos se les realizó manometría esofágica evolutiva entre los 6 y 18 meses después de la operación. Se encontró notable mejoría clínica en todos los pacientes, aunque persistió una disfagia ocasional mínima a sólidos en el 64,7 por ciento y dolor retroesternal ligero en el 47 por ciento. La presión del esfínter esofágico inferior disminuyó de X= 47,7 mm Hg a X= 17,5 mm Hg (p < 0,01). La relajación del esfínter esofágico inferior aumentó de X= 59 por ciento a X= 75,5 por ciento. (p < 0,01). La presión intraesofágica se normalizó en el 70,6 por ciento de los casos, (p < 0,05). Persistió el aperistaltismo en los pacientes operados y asimetría del esfínter esofágico inferior en el 82,4 por ciento. Tras la valoración clínica y manométrica, se consideraron satisfactorios los resultados de la cirugía laparoscópica en el grupo estudiado(AU)

Esophageal achalasia is a primary motor disorder with abscence of peristaltism and incapacity for relaxation of the lower esophageal sphincter. The present study was aimed at comparing the clinical evolution and manommetric characteristics of the esophagus of patients with esophageal achalasia before and after laparoscopic surgery. A prospective descriptive study was conducted in 17 patients (6 males and 11 females) aged 38-70 with radiological and endoscopic diagnosis of esophageal achalasia confirmed by manometric study. Later on, these patients underwent surgical treatment by Heller esophagocardiogram with Toupet or Dor's antireflux funduplication by randomized video-assisted laparoscopy. Evolutive esophageal manometry was performed in all of them between 6 and 18 months after surgery. A marked clinical improvement was found in all the patients, although a minimal occasional dysphagia to solids persisted in 64,7 percent, and mild retrosternal pain in 47 percent. The pressure of the lower esophageal sphincter decreased from X= 47,7 mm Hg to X= 17,5 mm Hg (p < 0.01).The relaxation of the lower esophageal sphincter increased from X= 59 percent to X= 75,5 percent. (p < 0.01).The intraesophageal pressure was normal in 70,6 percent of the cases, (p < 0.05). Aperistaltism persisted in the operated on patients and the asymmetry of the esophageal sphincter in 82,4. The results of laparoscopic surgery in the studied group were considered satisfactory after the clinical and manometric assessment..(AU)

Valoración manométrica del esófago de pacientes operados de acalasia mediante cirugía laparoscópica / Manometric assessment of the esophagus in patients operated on of achalasia by laparoscopic surgery

La acalasia esofágica es un trastorno motor primario con ausencia de peristaltismo e incapacidad de relajación del esfínter esofágico inferior. El presente estudio tuvo como objetivo comparar la evolución clínica y las características manométricas del esófago de pacientes con acalasia esofágica, antes y después cirugía laparoscópica. Se realizó un estudio prospectivo descriptivo con 17 pacientes (6 del sexo masculino y 11 del femenino), con edad comprendida entre 38 y 70 años y diagnóstico radiológico y endoscópico de acalasia esofágica, confirmado por estudio manométrico. Posteriormente, estos pacientes fueron sometidos a tratamiento quirúrgico, mediante esofagocardiomiotomía de Heller con funduplicatura antirreflujo de Dor o Toupet, por videolaparoscopia de forma aleatoria. A todos se les realizó manometría esofágica evolutiva entre los 6 y 18 meses después de la operación. Se encontró notable mejoría clínica en todos los pacientes, aunque persistió una disfagia ocasional mínima a sólidos en el 64,7 por ciento y dolor retroesternal ligero en el 47 por ciento. La presión del esfínter esofágico inferior disminuyó de X= 47,7 mm Hg a X= 17,5 mm Hg (p < 0,01). La relajación del esfínter esofágico inferior aumentó de X= 59 por ciento a X= 75,5 por ciento. (p < 0,01). La presión intraesofágica se normalizó en el 70,6 por ciento de los casos, (p < 0,05). Persistió el aperistaltismo en los pacientes operados y asimetría del esfínter esofágico inferior en el 82,4 por ciento. Tras la valoración clínica y manométrica, se consideraron satisfactorios los resultados de la cirugía laparoscópica en el grupo estudiado.

Esophageal achalasia is a primary motor disorder with abscence of peristaltism and incapacity for relaxation of the lower esophageal sphincter. The present study was aimed at comparing the clinical evolution and manommetric characteristics of the esophagus of patients with esophageal achalasia before and after laparoscopic surgery. A prospective descriptive study was conducted in 17 patients (6 males and 11 females) aged 38-70 with radiological and endoscopic diagnosis of esophageal achalasia confirmed by manometric study. Later on, these patients underwent surgical treatment by Heller esophagocardiogram with Toupet or Dor's antireflux funduplication by randomized video-assisted laparoscopy. Evolutive esophageal manometry was performed in all of them between 6 and 18 months after surgery. A marked clinical improvement was found in all the patients, although a minimal occasional dysphagia to solids persisted in 64,7 percent, and mild retrosternal pain in 47 percent. The pressure of the lower esophageal sphincter decreased from X= 47,7 mm Hg to X= 17,5 mm Hg (p < 0.01).The relaxation of the lower esophageal sphincter increased from X= 59 percent to X= 75,5 percent. (p < 0.01).The intraesophageal pressure was normal in 70,6 percent of the cases, (p < 0.05). Aperistaltism persisted in the operated on patients and the asymmetry of the esophageal sphincter in 82,4. The results of laparoscopic surgery in the studied group were considered satisfactory after the clinical and manometric assessment.

Epidemiologic aspects of American visceral leishmaniasis in an endemic focus in Eastern Venezuela.

An endemic focus of American visceral leishmaniasis (AVL) in eastern Venezuela has been evaluated in terms of patients (n = 48), immunologic reactivity to Leishmania in household contacts (n = 187) and neighborhood controls (n = 170), detection of Leishmania (L. donovani complex) in dogs and wild animals by the polymerase chain reaction (PCR) and characteristics of the sandfly population. The male:female ratio of patients was 1.18:1; 89.6% were < or =12 years old. Serologic reactivity was significantly higher in household contacts than in controls (P = 0.0008), as was the size of leishmanin reactions in contacts < or =10 years of age (P = 0.0141). Leishmania donovani complex-specific PCRs were positive in dogs, an opossum (Didelphis marsupialis), and a black rat (Rattus rattus). Lutzomyia longipalpis and Lu. evansi, both implicated in the transmission of AVL, were identified among the 386 sand flies examined. These observations provide the bases for an active control program as well as further studies of reservoirs and vector-host relationships in this area.

Leprosy in women: characteristics and repercussions.

"Health is often measured in terms of low mortality; nevertheless, merely being alive is not a measure of the quality of life" H. Méndez Castellanos. Physiological, socioeconomic and cultural factors play important roles in the response of women to Mycobacterium leprae and in the impact of leprosy on their lives. They appear to develop stronger immunological responses to M. leprae than men, as suggested by lower incidence and less severe clinical forms of disease in most areas of the world, as well as stronger reactions of cell-mediated immunity after prophylactic vaccination. Genetic factors and physiological status including pregnancy, intercurrent infection and malnutrition might be among the factors which modulate this response. Women in leprosy-endemic areas of the world, with few exceptions, suffer from marked economic and social dependency and inferiority which can only be heightened by the social stigma associated with leprosy. Nevertheless, they bear an enormous responsibility for the health of their families, often as head of the household, and they often possess a unique capacity to influence community opinion. With the introduction of multidrug therapy, leprosy control throughout the world is no longer an unrealistic goal. Active vaccination may constitute the other factor necessary for eventual eradication of the disease. The incorporation of women at all levels into active roles in health care programs may constitute one of the decisive factors in the success or failure of leprosy control.

[1st finding of the Ancylostoma braziliense nematode (Gómez de Faria, 1910) in Canis familiaris in Cuba]. / Primer hallazgo del nematodo Ancylostoma braziliense (Gómez de Faria, 1910) en Canis familiaris de Cuba.

According to the results obtained by investigators who have been devoted up to date to the study of dog helminthiases in Cuba dog ancylostomiasis is produced by Ancylostoma caninum. Now, Ancylostoma braziliense (Gómez de Faria, 1910) has been found in two dogs from the Havana province. The knowledge of the invasion extension as well as of the intensity of infestation should wait for the exhaustive study of the collected material.