Colangiografía intraoperatoria. Análisis observacional: tiempo, complicaciones y estancia hospitalaria / Intraoperative colangiography. Observational analysis: time, complications and hospital stay

Introducción: Desde su introducción en la década de 1930, las colangiografías intraoperatorias se han utilizado para comprender la anatomía biliar y sus variantes, para detectar coledocolitiasis y lesiones quirúrgicas del conducto biliar principal (LQVBP). Métodos: Las colangiografías intraoperatorias aleatorias se analizaron retrospectivamente durante el período de julio de 2019 a enero de 2023 en el hospital Nacional de Clínica. Resultados: El tiempo promedio de las colangiografías intraoperatorias fue de 16 minutos (2´ - 30´). Discusión. La colangiografía intraoperatoria es un procedimiento seguro, con una morbilidad de 0.66% en la serie. Conclusión: Las colangiografías intraoperatorias son un método intraoperatorio seguro y efectivo que no tiene implicaciones negativas para la evolución del paciente

Introduction. Since its introduction in the 1930s, the intraoperative cholangiographies has been used to understand the biliary anatomy and its variants, to detect choledocholithiasis and surgical lesions of the main bile duct (LQVBP). Methods. Random intraoperative cholangiographies were retrospectively analyzed during the period from July 2019 to January 2023 at the Hospital Nacional de Clínicas. Results. The average time of the intraoperative cholangiographies was 16 minutes (2´ - 30´). Discussion. Intraoperative cholangiography is a safe procedure, with a morbidity of 0.66% in the series. Conclusión. intraoperative cholangiographies is a safe, effective intraoperative method that does not have negative implications for the evolution of the patient.

Tactile Stimulation in Adult Rats Modulates Dopaminergic Molecular Parameters in the Nucleus accumbens Preventing Amphetamine Relapse.

Amphetamine (AMPH) is a psychostimulant drug frequently related to addiction, which is characterized by functional and molecular changes in the brain reward system, favoring relapse development, and pharmacotherapies have shown low effectiveness. Considering the beneficial influences of tactile stimulation (TS) in different diseases that affect the central nervous system (CNS), here we evaluated if TS applied in adult rats could prevent or minimize the AMPH-relapse behavior also accessing molecular neuroadaptations in the nucleus accumbens (NAc). Following AMPH conditioning in the conditioned place preference (CPP) paradigm, male rats were submitted to TS (15-min session, 3 times a day, for 8 days) during the drug abstinence period, which were re-exposed to the drug in the CPP paradigm for additional 3 days for relapse observation and molecular assessment. Our findings showed that besides AMPH relapse, TS prevented the dopamine transporter (DAT), dopamine 1 receptor (D1R), tyrosine hydroxylase (TH), mu opioid receptor (MOR) increase, and AMPH-induced delta FosB (ΔFosB). Based on these outcomes, we propose TS as a useful tool to treat psychostimulant addiction, which is subsequent to clinical studies; it could be included in detoxification programs together with pharmacotherapies and psychological treatments already conventionally established.

Binge and Subchronic Exposure to Ketamine Promote Memory Impairments and Damages in the Hippocampus and Peripheral Tissues in Rats: Gallic Acid Protective Effects.

Ketamine (KET) is a dissociative anesthetic for restrict medical use with high potential for abuse and neurotoxicity which does not prevent its recreational use. Gallic acid (GA) is a natural free radical "scavenger." We evaluated the GA protective role regarding binge or subchronic (SbChro) KET-induced toxicity in adolescent rats. In the binge protocol, animals were treated with GA (one dose of 13.5 mg/kg, p.o. every 2 h, totaling 3 doses) 12 h after KET exposure (one dose of 10 mg/kg, i.p., every 3 h, totaling 5 doses). In the SbChro, animals were treated with GA (one dose of 13.5 mg/kg/day, p.o., for 3 days) 48 h following KET exposure (one dose of 10 mg/kg/day, i.p) for 10 days. Our findings show that binge-KET impaired memory, increased pro-BDNF and TrkB levels in the hippocampus, and increased lipid peroxidation (LP) in the kidney and hippocampus, while SbChro-KET impaired memory, increased pro-BDNF, and decreased both BDNF and TrkB levels in the hippocampus, and increased LP in the kidney, liver, and hippocampus. GA treatment reversed the subchronically KET-induced harmful influences better. Interestingly, only memory impairment observed in the SbChro-KET protocol was reversed by GA. Memory impairments showed a positive correlation with hippocampal BDNF levels and negative with LP levels in the same brain area. This last hippocampal damage (LP) showed a negative correlation with BDNF levels in the hippocampus, indicating an interesting and close causal connection. Our outcomes show that the deleterious effects of SbChro-KET exposure can be attenuated or abolished with GA administration, a natural antioxidant that could be considered in KET abuse treatment.

Influence of different processing procedures on the reproductive capacity of Trichinella spiralis in pork meat.

The aim of this work was to determine the influence of different processing procedures and preparations on the viability and infectivity of Trichinella spiralis ML. The muscles of limbs tongue and masseters of pigs experimentally infected were collected, splitted to pieces, and pooled. Five batches were used for the following processing procedures: (1) seasoning with "adobo", commercially acquired chilli and several other spices, (2) "wet-curing" by immersion of meat pieces in 3% brine during 24 hours, (3) cold storage without any further processing or preparation, (4) freezing to -20 degrees C and, (5) drying for 24 hours at 60 degrees C. Samples were stored at 4 degrees C for 15, 45, 60, 75, 90, 105 or 266 days after preparation. At the last-mentioned dates, ML were recovered and used to determine the reproductive capacity by infecting naïve mice. The state of meat conservation or spoilage respectively was tested by visual and tactile examination. In samples treated by freezing or drying no motile larvae were found after artificial digestion and, following inoculation of mice with larvae recovered from these groups, no ML were founded after 40 days of infection. After the artificial digestion of the cold stored samples, the ones seasoned with "adobo" and "wet-cured", a number of motile ML were consistently obtained. Initial reproductive capacity index was as of 80+/-0.5, then rates decreased to 60 - 70 between days 15 and 105 PT and dropped to 40+/-6.7 at day 266 for seasoned, 33+/-2.7 for cold-stored and 33+/-2.5 for cured samples. The influence of storage time (p=0.000005; factorial ANOVA) but not for processing procedure (p=0.724; factorial ANOVA) were statistically significant. The sensorial examination of the meat samples showed severe changes caused by spoilage in odour, texture and colour from day 45 of storage. Data reported from this trial proves that curing or flavoring do not inactivate the Trichinella Mexican strain, although cold storage for more than three months led to a partial decrease of the reproductive capacity. Freezing and drying seemed to be effective measures to eliminate the ML infectivity.

Searching for antibodies against Trichinella spiralis in the sera of patients with fever of unknown cause.

Human cases of trichinellosis are often difficult to identify because the signs and symptoms of the disease, if the infection produces any at all, are non-specific, being similar to those observed in several other infectious diseases. In an investigation of Mexican patients with fever of unknown aetiology, attempts were made to develop a serodiagnostic test for the detection of antibodies specific for Trichinella spiralis. The excretory and secretory products of T. spiralis larvae (from the muscle tissue of experimentally infected rats) were used as the antigens in an enzyme-linked immuno-electrotransfer blot assay. The sera tested came from patients with fever of unknown cause (N=250), patients confirmed to have infectious or parasitic diseases other than trichinellosis (N=134) and 168 apparently healthy subjects. Overall, 4% of the samples from the febrile group, 1.8% of those from the healthy subjects but none of the sera from those with 'other diseases' reacted with the antigens of interest (of 45, 49 and 55 kDa). The results not only confirm that human infection with T. spiralis may be asymptomatic but also indicate that such infection may be mis-diagnosed.

Detection of circulating and fecal Trichinella spiralis antigens during experimental infection using monoclonal antibodies against the new born larvae.

Different assays to detect antigens of Trichinella spiralis during current infection have been standardized, although sensitivity values have been the main limitation to use them as routine diagnostic test. We report the production and use of monoclonal antibodies (MAbs) against the new born larvae which recognize both somatic and metabolic antigens from adult and muscular larvae (ML). We used two IgG3 MAbs (4B1, 4B2) and two IgG2a (2D3, 2D4) to detect antigens during experimental infection. All MAbs detect fecal antigens starting the second to third week post infection (wpi), although it was less clear with MAbs 4B1 and 4B2, while circulating antigens were detected from third to fourth wpi. Thus, the recognition of shared antigens among T. spiralis developmental stages can be used for early diagnosis of trichinellosis.

Serological evaluation of thin-layer immunoassay-enzyme-linked immunosorbent assay for antibody detection in human trichinellosis.

A new immunoenzymatic test, named the thin-layer immunoassay-enzyme-linked immunosorbent assay (TIA-ELISA), was evaluated for antibody detection in human trichinellosis using excretion and secretion products prepared from Trichinella spiralis muscle larvae. Serum samples from people with positive muscle biopsies or symptoms compatible with the disease (n = 8 or 26, respectively), all reactive in enzyme-linked immunoelectrotransfer blot assay (EITB), as well as 67 serum samples from healthy, EITB-negative people, were tested in an ELISA and TIA-ELISA. TIA-ELISA was performed in polystyrene plastic petri dishes by adding dots of 10 microl each of antigen (7 microg/ml) followed by adding diluted serum and the conjugate. Finally, the substrate mixed with agar was added to develop the reaction. Enzymatic by-products were easily detected by the naked eye as defined dots. Sensitivity and specificity were 76 and 94% for ELISA, and both parameters were 91% for TIA-ELISA. The kappa correlation indices for both tests in relation to EITB were 0.73 and 0.80, respectively. The TIA-ELISA can be carried out with common laboratory equipment in 3 h and uses lower quantities of antigen than EITB and ELISA. Since TIA-ELISA is easy to perform, cheap, sensitive, and specific, the test could be an acceptable alternative to use in clinical laboratories lacking specialized equipment needed for ELISA and EITB and in field studies for antibody detection in human trichinellosis.

[Search for antibodies against Trichinella spiralis in free roaming rodents caught in a zoological park from Mexico City]. / Búsqueda de anticuerpos contra Trichinella spiralis en roedores de libre desplazamiento capturados en un zoológico de la Ciudad de México.

A serological survey to search for antibodies against T. spiralis was performed in free roaming rats (n = 64) and mice (n = 35) caught in a zoological park from Mexico City. Serum samples were analyzed by ELISA and immunoelectrotransfer blot assay (EIBT). None serum show positive absorbance values in ELISA nor recognized T. spiralis specific antigenic fractions in EIBT. However, two rat samples recognized three antigens of 31, 37 y 55 kDa, while one of them reacted with two additional antigens of 64 and 67 kDa. As it is known that the antigen epitope profiles varied among Trichinella species, it could be possible that in rats, there is 3% of antibody prevalence against Trichinella sp.; however, due that other organisms could induce the production of cross-reacting antibodies, such conclusion can not be supported at all. These results suggest that T. spiralis was not part of helminthological fauna in these rodents.

[Hartmann's procedure. Institutional experience with 92 consecutive cases]. / Operación de Hartmann. Experiencia institucional de 92 casos consecutivos.

BACKGROUND: Since it's description in 1923, Hartmann's procedure is widely used for the surgical treatment of acute left colonic complications when preoperative bowel lavage is not feasible and/or there is high risk of anastomotic dehiscence. OBJECTIVE: Analyze the results of Hartmann's operation in the surgical treatment of consecutive patients at a single institution during a 30-month interval. TYPE OF STUDY: Prospective, non-randomized and longitudinal study. MATERIAL AND METHODS: Patients treated with the Hartmann procedure between March 1995 and September 1998. Surgical indication, intraoperative findings, morbidity and mortality were analyzed as well as the rate of reestablishment of bowel continuity and it's morbimortality. RESULTS: Ninety-two patients underwent a Hartmann procedure. The mean patient's age was 60 +/- 25 years (range of 21 to 88 years) and 60% were older than 65 years. An emergency operation was carried out in 91% of the cases. Most of the patients had intra-abdominal sepsis (56%) and benign colonic process (83%). The morbidity rate was 34% and mortality rate 19. During follow-up the bowel continuity was reestablished in 32% of the cases without fatalities. CONCLUSIONS: Hartmann's procedure is a good option for non-elective surgical treatment complicated rectosigmoid pathology. The morbidity and mortality of the operation are highly dependent on the degree of preoperative sepsis and the patient's preexisting condition. The rate of reestablishment of bowel continuity was low probably because of short follow-up.

Prevalence and risk factors associated with serum antibodies against Trichinella spiralis.

The presence of antibodies against Trichinella spiralis was investigated in a semi-rural county of Mexico using ELISA and electroimmunotransfer blot assay with crude larvae and ES antigens. The association of antibodies to several social, hygienic and dietary factors was also investigated. Antibody prevalences between 1.0 and 1.9% were found. Risk factors associated were gender female and ingestion of moronga, a pork meat sausage-like product. Our results suggest the presence of an endemic, unnoticed form of human trichinellosis. These observations may be relevant for other countries, especially in rural and semi-rural areas, where sylvatic and domestic life-cycles of Trichinella coexist.

[Comparative study of soft diet or clear liquids in the resumption of oral intake in the postoperative period]. / Análisis comparativo entre reinstalar la vía oral en el postoperatorio con dieta blanda o líquidos claros.

BACKGROUND: The reinstitution of oral intake in patients who have undergone intraabdominal surgery has traditionally progressed in a stepwise fashion beginning with clear liquids, liquid diet and after an adequate tolerance regular diet. OBJECTIVE: To determine if the reinstitution of oral intake after major abdominal surgery with regular diet offers benefits into which it's not harmful for patients and reduce the in-hospital stay. TYPE OF STUDY: Prospective, randomized, open study conducted between October 1996 to May 1997. MATERIAL AND METHODS: Patients aged 18 and older submitted to elective or urgent surgery of the abdomen and pelvis were included with the exception of: bariatric surgery, esophageal resection, pyloroplasty, pancreato-duodenal resection, laparoscopic surgery and patients under ventilatory support or with enteral or parenteral nutrition. As soon as postoperative ileus disappeared patients were randomly assigned to receive regular diet (group 1) or clear liquids (group 2) as the first oral intake. Oral diet tolerance was evaluated as well as the caloric and protein intake, the in-hospital stay and the cost. RESULTS AND MEASUREMENTS: Group 1 was conformed by 63 patients, and group 2 for 69 patients. There was no difference between, sex, age, kind of surgery (elective or emergency) and the type of pathology. 96.6% of patients in group 1 tolerated regular diet and 96.9% of patients in group 2 tolerated clear liquids. Only two patients of each group required oral intake suspension. The in-hospital stay was 2.6 +/- 2.0 days in group 1 against 3.4 +/- 2.6 in group 2 (P = < 0.005), the cost of the in-hospital stay period after the beginning of oral intake was 2726 +/- 2107 pesos in group 1 against 3547 +/- 2690 in group 2 (P = < 0.005), the caloric and protein intake were 1307 +/- 523 Kcals with 55.9 +/- 23.2 grams of proteins in group 1 and 651 +/- 204 Kcals and 0 grams of proteins in group 2 (P = < 0.00001). CONCLUSIONS: No difference was found in adverse reactions with the use of regular diet as the first meal. The in-hospital stay and the cost were reduced significantly and the calories and grams of proteins are higher in group 1. These results suggest that the routine use of clear liquids as the initial postoperative diet may be unnecessary and nutritionally suboptimal when compared with regular diet.

[Measured versus estimated energy expenditure at rest in critically ill patients]. / El gasto energético en reposo, medido contra estimado, en pacientes críticamente enfermos.

UNLABELLED: Differences between the indirect calorimetry (Ic) and Harris-Benedict method (HBM) to assess the caloric demand in critically ill patients were determined using a manual procedure to measure Ic. Forty patients were evaluated by both methods. Activity and lesion factors were included for HBM regarding each case. Ic was based on gas analysis (O2 and CO2) of an expired/inspired sample by means of Weir equation and Lusk tables. The comparison between Ic and HBM alone did not show differences. Results showed statistically significant differences when Ic and HBM plus activity and lesion factors were compared. Ic showed higher confidence and precision in critically ill patients (p < 0.05 and p < 0.001. Student's t test). CONCLUSIONS: The HBM failed to show an appropriate correlation in these patients as other published data. The procedure manual in Ic has value and can be use in second level hospitals.

[Morbidity, mortality, and total parenteral nutrition in esophageal and gastric surgery for benign pathology]. / Morbimortalidad y nutrición parenteral total en cirugía esofágica y gástrica por patología benigna.

We performed a retrospective study in patients undergoing mayor elective surgery of the upper gastrointestinal tract for benign disease receiving perioperative total parenteral nutrition (TPN). We analyzed the clinical charts from patients admitted to the Hospital de Especialidades del Centro Médico de Occidente for this purpose from January 1983 to March 1987, selecting those who had clinical or laboratory criteria of severe malnutrition. They were divided in two groups depending on whether TPN was being indicated as preoperative preparation and continued through the postoperative period (GE = 32 patients), or initiated after surgery (GC = 13 patients). The results show statistical differences in morbidity (GC = 100%, GE = 27%), mortality (GC = 30%, GE = none), need of reoperation (GC = 30%, GE = none) and costs (higher in GE). Complications related to TPN in GC were 23% and 15% in GE, and there were no deaths related on either group. Based on our results, we consider the need of a good selection of candidates to receive preoperative and postoperative TPN when undergoing major elective surgery, which should be continued until they are able to cover their nutritional requirements by oral or enteral route. This applies whenever there is sufficient clinical and laboratory data of severe malnutrition.

[Surgical revision and correction of choledochal cysts]. / Revisión y corrección quirúrgica de quistes del colédoco.

Choledochal cyst are a rare congenital abnormality, seldom treated by the General Surgeon. We report six cases of re-operation found on a eighth year period. Six cysts type I, and one type II (Todani's Classification) were found. On five of them, an internal derivation had been performed, in one patient only a celiotomy was performed, and in another one a colecistectomy. Complete resection of the cyst was performed in six cases. In one female patient, this was impossible, because a carcinoma was found, she died postoperatively. We recommend external bile duct drainage for those cases where a complete resection can not be performed. This option alleviates the symptoms, allows morphological studies and do not compromise the final procedure which must be the complete excision of the cyst.

[Post-traumatic diaphragmatic rupture. Report of 20 cases]. / Ruptura diafragmática post-traumática. Reporte de 20 casos.

From 1977 to 1987, 20 patients (18 men and 2 women) with left post-traumatic diaphragmatic rupture, were managed by the General Surgery Service of the Hospital de Especialidades, Centro Médico de Occidente, IMSS; 13 as urgencies (65%) and 7 as elective procedures (35%). Hernia was due to closed trauma in 80% of the cases. Predominant symptoms were chest pain (85%) and dyspnea (50%). The Stomach was the herniated viscus in 16 instances. CXR showed suggestive data in 95% of the cases. Primary closure was achieved in 95% of the cases, in 8 patients thoraco-abdominal aproach was necessary. There were 50% morbidity (35% athelectasis, 30% wound sepsis) and 10% mortality rates.

[Complications of the surgical treatment of reflux esophagitis]. / Complicaciones en el tratamiento quirúrgico de la esofagitis por reflujo.

The complications presented by 36 patients submitted to anti-reflux procedures that were treated in our Hospital in a 10 year period, from September 1978 to May 1988, are analyzed. The patients were divided in 2 groups depending on the initial treatment being performed inside or outside our Hospital. The indication for the initial operation was reflux esophagitis in all patients, 4 or whom, had developed a shortened esophagus with stenosis. The selected procedures were of several types with a clear predilection for the Nissen type fundoplication with its variants. Different kinds of complications were observed; mortality was associated with gastric or esophageal leak, with a fatal outcome in 11 patients, another one died of postoperative pancreatitis and abdominal sepsis (33.3 percent mortality rate).

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