Patient satisfaction and quality of life following laparoscopic Nissen fundoplication.

BACKGROUND: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life. OBJECTIVES: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication. PATIENTS AND METHODS: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale. RESULTS: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent. CONCLUSIONS: The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled.

Effect of increasing trypsin concentrations on seminal coagulum dissolution and sperm parameters in spider monkeys (Ateles geoffroyi).

Seminal coagulum formation in spider monkeys (Ateles geoffroyi) interferes with the efficient recovery and evaluation of spermatozoa. The main objective was to assess the effect of increasing concentrations of trypsin on dissolution of seminal coagulum and spermatic parameters. Seminal coagulum was incubated at 37 °C without trypsin or in the presence of increasing trypsin concentrations (0.1%, 1.0%, and 5.0%). For each sample, coagulum dissolution time was measured, and sperm concentration, viability, motility, and morphology were evaluated using light microscopy and/or transmission electronic microscopy (TEM). Trypsin concentrations of 1.0% and 5.0% more rapidly liquefied seminal coagulum, averaging 32 and 21 min, respectively, compared with nontrypsinized controls, with maintenance of greater sperm viability (70.8% and 72.5%, respectively). Coagulum treated with 1.0% trypsin and the liquid ejaculate fraction averaged higher sperm motility (40.1% and 55.6%, respectively) than control samples, and both 1.0% and 5.0% trypsin treatment allowed recovery of increased numbers of motile spermatozoa. There was greater sperm fragmentation at the head and midpiece level after treatment with 1.0% and 5.0% trypsin (55.8% and 55.9%); however, the percentage of normal morphology in structurally intact spermatozoa did not differ relative to controls. With transmission electronic microscopy imaging, there were similar percentages of spermatozoa with plasma membrane swelling in the midpiece and acrosomal regions in trypsin-treated samples and controls. In conclusion, trypsin treatment of spider monkey seminal coagulum exerted a concentration-dependent effect on dissolution time and various spermatic parameters. Higher trypsin concentrations caused more rapid liquefaction of coagulum and recovery of greater numbers of motile spermatozoa, but may adversely affect fragmentation of spermatozoa and could compromise sperm function and cryopreservation potential.

Epididymal stereocilia in semen of infertile men: evidence of chronic epididymitis?

As free stereocilia in semen samples from infertile men could be related to a subclinical chronic infection of the seminal tract, we carried out a retrospective analysis of 14 files of infertile men with stereocilia in semen (group 1) and in two control groups: 30 infertile men from the same study population (group 2) and 40 fertile sperm donors (group 3). Clinical, bacteriological, sonographic and microscopic findings associated with these semen samples were compared. Epididymal cysts were found in two of 14 men in group 1 and in four of 28 in group 2. Positive semen cultures for Chlamydia trachomatis, Mycoplasma hominis or Ureaplasma urealyticum (chi(2) = 8.20; P = 0.002; OR: 7.22) and varicocele (chi(2) = 8.96; P = 0.002; OR: 2.25) were associated to the presence of free stereocilia in semen. These data suggest that a silent chronic infection of the epididymis by C. trachomatis, M. hominis, U. urealyticum and/or inflammation produced by varicocele might be the cause of stereocilia loss in the semen.

Further ultrastructural characterization of the intranuclear ring-shaped bodies of the plant Lacandonia schismatica.

Ring-shaped bodies are found in the nucleus of Lacandonia schismatica, a rare plant with the sexual organs inverted. They are 0.5-microm-diameter structures that present an electron-dense external ring surrounding a central core. Ultrastructural studies indicate that these bodies contain RNA. The external ring is labeled with antibodies against small nuclear ribonucleoproteins, suggesting that they may be involved in pre-mRNA metabolism. In the present work we further characterized these intranuclear ring-shaped structures by serial-sectioning analysis. Moreover, we tested the presence of additional molecular elements related to pre-mRNA metabolism, such as SR proteins and poly(A)(+) RNA, using immunoelectron microscopy and ultrastructural in situ hybridization. Our results show that these nuclear bodies are spherical. They contain SR proteins involved in splicing and postsplicing events and little to no poly(A)(+) RNA. We also found similar nuclear bodies in other plant and animal species. Therefore, ring-shaped bodies in L. schismatica are spherical, highly compartmentalized nuclear structures that may be involved in pre-mRNA metabolism.

[Radiologic, densitometric, morphologic and electron microscopic study of osteoporosis and osteopenia in the third lumbar vertebra in men and women in the city of Mexico]. / Estudio de la osteoporosis y osteopenia por medio de radiología, densitometría, morfometría y microscopia de barrido en la tercera vértebra lumbar en una muestra de hombres y mujeres en la ciudad de México.

OBJECTIVE: To determine bone density in the third lumbar vertebra in a group of men and women from the Mexico City correlating the morphometric characteristics of vertebral body by specific techniques and to detect groups with alterations like osteoporosis or osteopenia. METHODOLOGY: The study was made in third lumbar vertebra from 23 patients dead of the Medical Service Forense-México, 8 women between 31 to 72 years old and 15 men between 25 yo 62 years old. The studies were: Radiological, bone densitometry and by image in which was determined density of vertical and horizontal trabeculaes. With x-ray technique in scanning electron microscopy was determined in form semiquantitative the presence of Ca, P, Mg and Na, and Ca distribution by technique of x-ray energy dispersed. RESULTS: In the radiological trail all vertebras of the female group were abnormal, the major finding was degenerative feature; 5 Showed trabeculation increased 3 fractured; in the males group 7 patients were normal, degenerative fracture in 8; of these six had densitometry with DEXA; in the females group only one was normal, 3 osteopenia, 5 osteoporosis; in the male group: 5 osteopenia and 5 osteoporosis. Scanning electron microscopy examination exhibit a homogeneous and dense expression pattern, wherever SEM demonstrated the absence or decrease of deposit calcium in osteoporosis. A morphometric examination of the trabecular thickness demonstrates a difference between the two sexes. The normal median was 222.1 microns, the osteoporosis range was 126.3 to 156.2 microns in the female osteoporosis, in male group was found two normal values with a trabecular density mean of 249.7 microns, in the last two cases one with osteopenia and the other with osteoporosis, the mean value was 186.4 microns. CONCLUSIONS: In the present study, was demonstrated that the degenerative alterations in osteoporosis and osteopenia in young people are more frequent to respect other reports. The following observations require special emphasis either because they provide clues to the mechanism of altered expression of calcium: Genetic, ethnic, consume, sedentary and others.

[Duodenal stenosis: a rare complication of acute pancreatitis]. / Estenosis duodenal orgánica. Una complicación infrecuente de la pancreatitis aguda.

Duodenal stenosis is a rare complication of acute pancreatitis. We present 5 cases and suggest a protocol of treatment based on intubation of the stenosis and nutritional support via nasojejunal feeding tube. This non-invasive method facilitated adequate control in 3 of the 5 cases. Total parenteral nutrition should be left for cases with severe stenosis, and surgery for those in which conservative treatment fails after a period of five weeks.

[Bacterial vaginosis. Relation between the vaginal flora and the vaginal epithelial cells under different treatments. Ultrastructural study]. / Vaginosis bacteriana. Relación de la flora vaginal con las células epiteliales de vagina, con diferente tratamiento. Estudio ultraestructural.

At this study we analyzed morphologic relation with vaginal ephitelium, in women with bacterial vaginosis, in pre-treatment; first post-treatment and second post-treatment using metronidazol (oral), and clindamycine (intra-vaginally). From 20 patients with bacterial vaginosis, 10 received oral metronidazol, 500 mg/b.i.d. during seven days; the other patients received, clindamycine 2% intravaginal, once a day, during seven days. Couples received metronidazol. In pre-treatment, cellular prolongations produced greater adhesion of bacteria, and rests of cellular unions with adhered bacteria. There was penetration of some bacteria to epithelial cells, confirming this with serial cuts and discarding superposition in the cells. This penetration was found in five cases y persisted during the first and second post-treatment. In the first post-treatment, cellular groups without bacteria, were found. The presence of lactobacillus was low, increasing afterwards. The presence of yeasts was in the first post-treatment, and in some cases persisted. It is important to differentiate intracellular bacteria and to know the related characteristics with bacterial penetration, for an adequate prescription and a better use of medication, avoiding possible damage. The presence of bacteria may be one of the causes for bacterial vaginosis reincidence.

[Ultrastructural analysis of placentas with villitis. Retrospective study]. / Análisis ultraestructural de placentas con villitis. Estudio retrospectivo.

A villitis is a focal or multifocal inflammatory reaction of chorionic villi with infiltration of mononuclear cells and usually is associated with fibrinoid necrosis. The aetiology of villitis could be a transplacental infection of the fetus, especially with virus (VIV), in normal placentae however, the presence of villitis is referred as villitis of unknown ethiology (VED). This study was designed to characterize villitis lesions of 11 placentae, four VIV and seven VED, ultrastructural descriptive comparisons of both types of villitis are discussed. Biopsies were processed with the conventional optic and electronic microscopy techniques. Our ultrastructural observations confirmed the presence of virus in four placentae whereas no virus or bacteria were found in seven placentae. Microvilli were absent or markedly diminished, this finding was associated to the presence of fibrinoid necrosis in the stroma and clinically to intrauterine growth retardation, 4 preterm pregnancies and one obitus. Trophoblast alterations were found in both types of villitis, basal membrane thickness, is some cases associated to electrodense material similar to calcium deposites, vascuolization and the presence of edema in the stroma was observed. In some cases we noted the presence of focal fibrin deposits associated to necrosis zones in the stroma, calcium precipitates and mielinic bodies. Fetal vessels obliteration and intravascular thrombi were found in the syncitiotrophoblast placentae with viral particles CMV or rubivirus associated to an increment in Hofbauer cells and basal membrane calcifications. From our ultrastructural observations, we conclude that both types of villitis are associated to a typic immunologic reaction that induce lose of trophoblast microvilli, mononuclear infiltration and edema. This placental alterations reduce dramatically the maternofetal exchange of gases, nutrients and other active peptides and could be the cause of fetal growth retardation, inmadurity or death.

[Gardnerella vaginalis infection in heterosexual couples. Ultrastructural study of desquamation cells of the stratified epithelium]. / Infección por Gardnerella vaginalis en parejas heterosexuales. Estudio ultraestructural en células de descamación del epitelio estratificado.

Bacterial vaginosis is one of the most frequent infections during the woman's reproductive age. Lactobacilli normal flora is substituted by relatively elevated Gardnerella vaginalis (GV), anaerobic bacteroids, Mobiluncus and Mycoplasma. The purpose of this study is to perform a morphological analysis of possible mechanisms for adhesion and penetration of GV in the heterosexual couple, in squamous epithelium at vaginal wall, as well as in seminal fluid. Ten couples with positive GV culture with three to four days of abstinence, were studied. The women presented with at least three of the four Amsel's criteria. Samples were obtained from vaginal lateral walls and from seminal fluid; these were divided in two parts: 1. To realize cultures for GV. Ureaplasma urealyticum and Mycoplasma hominis; and 2. For an ultrastructural analysis. Samples were processed with common techniques for electronic microscopy. In vaginal cells, bacteria similar to GV free form fixed to plasmatic membrane and inside the cellular cytoplasm. In the seminal fluid there were found numerous urethral cells of desquamation, which presented, as well as in woman, free form bacteria, fixed to plasmatic membrane and inside the cytoplasm. In four cases, bacteria similar to Mycoplasma, were found; and one case with particles suggesting cytomegalovirus. It is concluded in this study that: 1. The male presents with urethral cells similar to vaginal "guide cells". 2. GV colonizes urethral epithelium in the male. 3. Male is capable of infecting and/or re-infecting the woman.

[Rupture of splenic artery aneurysm as a cause of acute abdomen]. / Ruptura de aneurisma de arteria esplénica como causa de abdomen agudo.

A male, 52 years old, presenting acute abdominal pain and hypovolemic shock, was diagnosed by ultrasound and CAT of fissured aneurysm of the splenic artery. Emergency laparotomy confirmed that the aneurysm had ruptured into the peritoneal cavity.