Persistence of a vitelline artery on a Meckel's diverticulum as a cause of bowel infarction.

Meckel's diverticulum is a congenital anomaly, resulting from incomplete obliteration of the most proximal portion of the omphalomesenteric duct. It generally remains silent, but life-threatening complications may arise in 4-6% of the patients. We present a case of a 16-year-old male, who arrived at the emergency room with crampy abdominal pain, nausea, and vomiting, suggestive of acute appendicitis. Surgical exploration revealed 150 cm of infarcted small bowel, secondary to a mesodiverticular band of a Meckel's diverticulum at the site of obstruction. The ischemic small bowel with Meckel's diverticulum was resected, and an ileo-ileal anastomosis was carried out. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. He was seen 12 months after his initial surgery, with a favorable outcome.

Tipificación de serotipos del virus del papiloma humano de alto riesgo / Typification of high-risk human papilomavirus serotypes

Resumen: OBJETIVO: Identificar los serotipos más frecuentes de virus del papiloma humano mediante pruebas al azar en pacientes previamente diagnosticadas con cáncer cervicouterino. MATERIALES Y MÉTODOS: Estudio prospectivo y observacional, efectuado en pacientes con displasia cervical, atendidas en el Hospital Regional Materno Infantil de Alta Especialidad de Nuevo León, Monterrey, entre enero y marzo de 2016. Criterios de inclusión: pacientes mayores de 18 años, que acudieron a la unidad médica para seguimiento y control ginecológico, con reporte anormal en la prueba de Papanicolaou, confirmado por histopatología, mediante biopsia dirigida por colposcopia. Criterios de exclusión: mujeres con histerectomía total por indicación de enfermedad benigna, sin antecedente de neoplasia intracervical; mayores a 70 años después de 3 citologías cervicales negativas en la década previa; pacientes que recibieron quimioterapia, radioterapia u otros tratamientos farmacológicos y quienes acudieron a revisión médica durante su ciclo menstrual. Para el análisis de los datos se utilizó estadística descriptiva. RESULTADOS: Se registraron 30 pacientes. Las clasificaciones más frecuentes de neoplasia cervical fueron: NIC-1 (n = 15), NIC-2 (n = 9) y NIC-3 (n = 6). Todas las pacientes analizadas tuvieron, al menos, un serotipo de VPH de alto riesgo. Los serotipos identificados con mayor frecuencia fueron el 31 y 33 (n = 18). En 18 pacientes se encontraron 6 o más serotipos de VPH. De 15 pacientes con lesiones de alto grado, 8 tuvieron la asociación de serotipos 31 y 33, y en 6 se identificó un serotipo aislado (16 y 51). CONCLUSIONES: Los serotipos identificados con mayor frecuencia fueron el 31 y 33. Desafortunadamente, la vacuna nonavalente que protege contra los serotipos más frecuentes de VPH no se encuentra disponible en Latinoamérica.

Abstract: OBJECTIVE: To identify the most frequent serotypes of human papillomavirus through random testing of patients previously diagnosed with cervical cancer. MATERIALS AND METHODS: A prospective, observational study carried out in patients with cervical dysplasia, treated at the High Specialty Regional Maternal and Child Hospital of Nuevo León, Monterrey. Inclusion criteria: patients over 18 years of age, who attended the Dysplasia Clinic of the High Specialty Regional Maternal and Child Hospital for gynecological follow-up and control, with an abnormal result in the Papanicolaou test, confirmed by histopathology, by means of colposcopy-directed biopsy. Before the procedures (cervical cytology), Exclusion criteria: women with total hysterectomy due to indications of benign disease, without a history of intracervical neoplasia; older than 70 years after 3 negative cervical cytology in the previous decade; patients who received chemotherapy, radiotherapy or other pharmacological treatments and who received medical check-ups during their menstrual cycle. Descriptive statistics were used for data analysis. RESULTS: 30 patients were registered. The most frequent classification of cervical neoplasia was: CIN1 (n = 15), CIN2 (n = 9) and CIN3 (n = 6). All the patients analyzed had at least one high-risk HPV serotype. The most frequently identified serotypes were 31 and 33 (n = 18 of 30). 6 or more HPV serotypes were found in 18 patients. Of 15 patients with high-grade lesions, 8 had the association of serotypes 31 and 33, and in 6 an isolated serotype was identified (16 and 51). CONCLUSIONS: The most frequently identified serotypes were 31 and 33. Unfortunately, the nonavalent vaccine that protects against the most frequent serotypes of HPV is not available in Latin America.

Intragastric balloon placement for the management of obesity: improving patient selection.

OBJECTIVE: Review and determination of ideal characteristics for the management of obesity by intragastric balloon, in Monterrey, Mexico. METHOD: Retrospective analysis of 152 patients, with overweight and obesity from January 2009 to December 2015, to whom an intragastric balloon was placed. Demography, weight loss, decrease in body mass index (BMI) and complications were analyzed. The objective was to determine the group of patients that will benefit the most after endoscopic intragastric balloon placement. RESULTS: A sample of 120 women and 32 men was analyzed. As expected, greater weight loss was observed in patients with BMI > 40 (n = 10, 6.57%, m = 26.29 ± 5.69; p = 0.001) and the lowest in patients with a BMI < 29.9 (n = 24, 15.78 %). Greater satisfaction was detected among patients with an average loss of 15.24 ± 2.75 kg (p < 0.001), and greater indifference among patients with greater losses. There is a tendency among women towards dissatisfaction. CONCLUSIONS: The greatest weight loss was observed among patients with a BMI > 40, although the highest satisfaction was observed among men with an average BMI of 32, which is why we recommend the procedure for these patients. We consider it to be an excellent bridge procedure for patients with BMI > 50.

OBJETIVO: Revisión y determinación de las características ideales para el manejo de la obesidad por medio de balón intragástrico, en Monterrey, México. MÉTODO: Análisis retrospectivo de 152 pacientes, con sobrepeso y obesidad, de enero de 2009 a diciembre de 2015, a quienes se colocó un balón intragástrico. Se analizaron la demografía, la pérdida de peso, la disminución del índice de masa corporal (IMC) y las complicaciones. El objetivo fue determinar el grupo de pacientes que mejores resultados obtendrán tras la colocación del dispositivo por endoscopia. RESULTADOS: Se obtuvo una muestra de 152 pacientes, 120 mujeres y 32 hombres. Como era de esperar, se observó la mayor pérdida de peso en los pacientes con IMC > 40 (n = 10, 6.57%, m = 26.29 ± 5.69; p = 0.001) y la menor en los pacientes con IMC < 29.9 (n = 24, 15.78%). Se detectó una mayor satisfacción en los pacientes con una pérdida promedio de 15.24 ± 2.75kg (p < 0.001), y mayor indiferencia en los pacientes con mayores pérdidas. Se observa una tendencia en las mujeres hacia la insatisfacción. CONCLUSIONES: La mayor pérdida de peso se observó en los pacientes de IMC > 40, aunque la mayor satisfacción se observó en los hombres con IMC promedio de 32, por lo que lo recomendamos para estos pacientes. Consideramos que es un excelente procedimiento puente para pacientes con IMC > 50.